Ramírez-Prieto G, Pombo-Bartelt JE, Rojas-Calderón G, García-González JJ. Prescription of oral anticoagulation in geriatric patients with atrial fibrillation.
ARCHIVOS DE CARDIOLOGIA DE MEXICO 2022;
92:42-52. [PMID:
34153976 PMCID:
PMC8771042 DOI:
10.24875/acm.20000563]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
Objective
To determine the prevalence of prescription of oral anticoagulation in patients aged > 60 years with nonvalvular atrial fibrillation (NVAF).
Methods
Observational, cross-sectional, retrospective study based on a review of the clinical histories of patients aged >60 years diagnosed with NVAF from July 1 to September 30, 2019 and seen at the outpatient clinic (cardiology, internal medicine, geriatrics) of a secondary-level hospital in Queretaro, Mexico. Clinical profile and oral anticoagulant treatment were analyzed.
Results
The study population comprised 300 patients (mean age, 77.2±8.3 years; 53.3% women; 81% attended in cardiology). Of these, 91% had a high thromboembolic risk, 22.7% a high bleeding risk, and 1.7% contraindications for anticoagulation. Comorbidity was frequent. As for therapy, 82.7% were taking direct oral anticoagulants (DOAC), 11.0% vitamin K antagonists (VKA), and 6.3% no anticoagulant treatment. Anticoagulant therapy was inappropriate in 29.3% of patients, mainly because DOAC were prescribed without adjusting for age, weight, or serum creatinine and administered without indication according to thromboembolic risk. Only 39.4% of patients taking VKA were within the therapeutic range. Of all patients receiving DOAC, 48.0% were taking rivaroxaban, mainly at 20 mg/d (73.1%).
Conclusions
Thromboembolic risk is high in geriatric patients with NVAF. Anticoagulation is contraindicated in <2% of patients. Oral anticoagulants are prescribed inappropriately in three out of ten patients.
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