title: [Anticoagulation use in older patients with atrial fibrillation in a cardio-geriatric unit].
abstract: OBJECTIVE
  Older people with atrial fibrillation (AF) have an increased embolic risk but they are less frequently treated with anticoagulants. We wanted to assess our current practice in a specialized service.
  
  
  METHODS
  Prospective observational study including all patients older than 75 years admitted during 3 months in a cardio-geriatric unit. Patients' embolic risk (CHADS2 score), hemorrhagic risk (HAS-BLED score), anti-thrombotic treatment at arrival and any modification afterwards, were analyzed.
  
  
  RESULTS
  Thirty-four patients were included (mean age: 85 years). AF was known in 28 patients, of whom 20 were under anticoagulant therapy at their admission (10 fluindione, 9 warfarine, 1 dabigatran), 4 received aspirin and 4 no anti-thrombotic treatment. Only the treatment of one of these patients was modified, replacing aspirin by warfarin. AF was newly diagnosed in 6 patients, of whom anticoagulation were initiated in 4 patients (3 warfarine, 1 fluindione). Finally, 9 patients (26%) left the hospital without anticoagulant treatment. Reasons given by their attending doctors were: advanced dementia (4 patients), estimated excessive hemorrhagic risk (4), and estimated low embolic risk (1). There was a clear trend to initiate anticoagulation more frequently in patients with a newly diagnosed AF (P=0.09) CONCLUSIONS: A substantial proportion of older patients with AF do not receive anticoagulant therapy, even after having been admitted to a specialized service. Advanced dementia and hemorrhagic risk are the reasons most frequently given for that.
authors.affiliation: Service de gériatrie à orientation cardiologique, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, DHU FAST, faculté de médecine Paris 6 Pierre et Marie Curie, 7, avenue de la République, 94205 Ivry-sur-Seine, France.
authors.forename: H
authors.initials: H
authors.lastname: Yang
authors.affiliation: Service de gériatrie à orientation cardiologique, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, DHU FAST, faculté de médecine Paris 6 Pierre et Marie Curie, 7, avenue de la République, 94205 Ivry-sur-Seine, France.
authors.forename: W
authors.initials: W
authors.lastname: Jarzebowski
authors.affiliation: Service de gériatrie à orientation cardiologique, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, DHU FAST, faculté de médecine Paris 6 Pierre et Marie Curie, 7, avenue de la République, 94205 Ivry-sur-Seine, France; Faculté de médecine Paris 6 Pierre et Marie Curie, 95, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Nouhaud
authors.affiliation: Service de gériatrie à orientation cardiologique, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, DHU FAST, faculté de médecine Paris 6 Pierre et Marie Curie, 7, avenue de la République, 94205 Ivry-sur-Seine, France; Faculté de médecine Paris 6 Pierre et Marie Curie, 95, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Belmin
authors.affiliation: Service de gériatrie à orientation cardiologique, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, DHU FAST, faculté de médecine Paris 6 Pierre et Marie Curie, 7, avenue de la République, 94205 Ivry-sur-Seine, France; Faculté de médecine Paris 6 Pierre et Marie Curie, 95, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: carmelo.lafuente@cfx.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Lafuente-Lafuente
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D005602:France; D006757:Hospital Units; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants; Atrial fibrillation; Fibrillation atriale; Hemorrhagic risk; Older patients; Patient âgé; Risque hémorragique