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Díez-Villanueva P, Jiménez-Méndez C, Ferreiro JL, Cepas-Guillén P, Bonanad C, García-Blas S, Ariza-Solé A, Sanchís J, Martínez-Sellés M. Non-ST Elevation Myocardial Infarction in the Elderly. Antithrombotic Therapy and Beyond. Rev Cardiovasc Med 2023; 24:201. [PMID: 39077013 PMCID: PMC11266491 DOI: 10.31083/j.rcm2407201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 07/31/2024] Open
Abstract
Non-ST segment elevation myocardial infarction (NSTEMI) is the most frequent type of acute coronary syndrome in the elderly. Antithrombotic therapy is the cornerstone of pharmacological therapy in the setting of an acute ischemic event, a clinical scenario in which thrombotic and bleeding risks ought to be considered, particularly in older patients. In this article, specific aspects of antithrombotic therapy in elderly patients with NSTEMI are reviewed, including pharmacokinetic and pharmacodynamic characteristics and different clinical situations. The role of frailty and other common geriatric conditions, that are associated with worse prognosis in elderly patients with cardiovascular disease, is also addressed.
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Affiliation(s)
| | - César Jiménez-Méndez
- Cardiology Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - José Luis Ferreiro
- Department of Cardiology, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, CIBERCV, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
| | | | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain
- Instituto de Investigación Sanitaria INCLIVA (JR/21/00041), 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Sergio García-Blas
- Instituto de Investigación Sanitaria INCLIVA (JR/21/00041), 46010 Valencia, Spain
- Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, CIBERCV, Spain
| | - Albert Ariza-Solé
- Department of Cardiology, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, CIBERCV, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
| | - Juan Sanchís
- Instituto de Investigación Sanitaria INCLIVA (JR/21/00041), 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, CIBERCV, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, CIBERCV, Spain
- Universidad Europea de Madrid, 28670 Madrid, Spain
- Universidad Complutense de Madrid, 28007 Madrid, Spain
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Manckoundia P, Rosay C, Menu D, Nuss V, Mihai AM, Vovelle J, Nuémi G, d’Athis P, Putot A, Barben J. The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186685. [PMID: 32937847 PMCID: PMC7558265 DOI: 10.3390/ijerph17186685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 01/12/2023]
Abstract
We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.
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Affiliation(s)
- Patrick Manckoundia
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
- UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy and Franche Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-3-80-29-39-70
| | - Clémentine Rosay
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Didier Menu
- Mutualité Sociale Agricole of Burgundy Franche Comté, 21000 Dijon, France;
| | - Valentine Nuss
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Anca-Maria Mihai
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Jérémie Vovelle
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Gilles Nuémi
- Department of Medical Information, University Hospital, University of Burgundy, 21000 Dijon, France; (G.N.); (P.d.)
| | - Philippe d’Athis
- Department of Medical Information, University Hospital, University of Burgundy, 21000 Dijon, France; (G.N.); (P.d.)
| | - Alain Putot
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Jérémy Barben
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
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Bayés de Luna A, Baranchuk A, Niño Pulido C, Martínez-Sellés M, Bayés-Genís A, Elosua R, Elizari MV. Second-degree interatrial block: Brief review and concept. Ann Noninvasive Electrocardiol 2018; 23:e12583. [PMID: 30175540 DOI: 10.1111/anec.12583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 01/18/2023] Open
Abstract
The advanced interatrial block (A-IAB) (P ≥ 120 ms plus ± pattern in II, III and aVF) corresponds at atrial level, to right or left advanced bundle branch block at ventricular level, and it is well known that these patterns may be seen transiently in relation to taquicardia or bradycardia (tachycardia or bradycardia dependent right or left bundle branch block). We present for the first time, the same phenomenon at atrial level. In one case, the A-IAB appears in relation to tachycardization and in the other disappears during a pause induced by ventricular premature complex.
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Affiliation(s)
- Antonio Bayés de Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Adrián Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - César Niño Pulido
- Cardiovascular Research Foundation. Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Antonio Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Research Group, REGICOR Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,CIBER Cardiovascular, Barcelona, Catalonia, Spain.,Medicine Department, Medical School, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
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Mostaza JM, Jiménez MJR, Laiglesia FJR, Peromingo JAD, Robles MB, Sierra EG, Bilbao AS, Suárez C. Clinical characteristics and type of antithrombotic treatment in a Spanish cohort of elderly patients with atrial fibrillation according to dependency, frailty and cognitive impairment. J Geriatr Cardiol 2018; 15:268-274. [PMID: 29915616 PMCID: PMC5997617 DOI: 10.11909/j.issn.1671-5411.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Available data regarding clinical profile and management of elderly patients with atrial fibrillation (AF) according to dependency, fragility and cognitive impairment are scarce. The objective of the study was to analyze the biodemographic data, clinical profile and antithrombotic treatment according to dependency, fragility and cognitive impairment in elderly AF patients. METHODS Cross-sectional and multi-center study performed in consecutive AF patients ≥ 75 years treated with oral anticoagulants ≥ 3 months attended in Internal Medicine Departments in Spain. RESULTS A total of 837 patients (83.0 ± 5.0 years; CHA2DS2-VASc: 5.0 ± 1.4; HAS-BLED: 2.1 ± 0.9) were included. 44.4% of patients had some degree of dependency, 43.3% were fragile, and 32.3% had cognitive impairment. Patients with any of these conditions were older, had a worse clinical profile, with more comorbidities and higher risks of thromboembolic and bleeding events. All these conditions were independently associated among them. Overall, 70.8% of patients were taking vitamin K antagonists, the remaining 29.2% direct oral anticoagulants and 9.7% oral antiplatelets. This distribution was independent of the presence of dependency or fragility, but there was a trend to a higher prescription of vitamin K antagonists in those patients with cognitive impairment (75.2% vs. 68.8%; P = 0.05). CONCLUSIONS Approximately 32%-44% of elderly anticoagulated AF patients attended have some degree of dependency, fragility and/or cognitive impairment. Patients with any of these conditions are older and have a worse clinical profile. Approximately 71% of patients are taking vitamin K antagonists, regardless dependency or frailty, but with a trend to higher prescription in patients with cognitive impairment.
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Affiliation(s)
| | | | | | | | | | | | | | - Carmen Suárez
- Hospital Universitario de La Princesa, Madrid, Spain
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