Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence.
Atrial fibrillation is more frequent in older patients, who have a higher risk of cardioembolic stroke and thromboembolism. Oral anticoagulant therapy is the standard of treatment for stroke prevention; however, under-prescription is still very common in older patients. The reasons underlying this phenomenon have not been systematically investigated, and true contraindications only partially account for it. An intimate skepticism on the real benefit-risk balance of oral anticoagulant therapy in the oldest patients seems to derive from the fact that most studies supporting it were conducted decades ago and included younger patients, with overall better functional and clinical status. In this review we will focus on the main barriers to anticoagulant therapy prescription in older patients and summarize the available evidences on the efficacy and safety of vitamin K antagonists and direct oral anticoagulants in this population. The encouraging evidence of a higher net clinical benefit of direct oral anticoagulants compared with warfarin should hopefully widen the treatment options also for frail individuals, thereby allowing a greater number of patients to be treated according to current international guidelines.
Section of Geriatrics and Bone Metabolic Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
Mario
M
Bo
Section of Geriatrics and Bone Metabolic Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
Enrica
E
Grisoglio
Section of Geriatrics and Bone Metabolic Diseases, Department of Medical Sciences, University of Turin, Turin, Italy. Electronic address: dott.brunettienrico@gmail.com.
Enrico
E
Brunetti
Section of Geriatrics and Bone Metabolic Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
Yolanda
Y
Falcone
Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy.
Niccolò
N
Marchionni
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000517:prevention & control; D013923:Thromboembolism / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014812:Vitamin K; D014859:Warfarin
Atrial fibrillation; Direct oral anticoagulants; Elderly patients; Oral anticoagulant therapy; Stroke prevention; Vitamin K antagonists