Traditional thromboprophylaxis in elderlies with atrial fibrillation: What we can achieve in real life

OBJECTIVESTo investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fibrillation (AF). BACKGROUNDAF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antago...

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Published in:Bratislavské lékarské listy Vol. 120; no. 10; pp. 764 - 768
Main Authors: Dubrava, M, Nemeth, F, Drobna, T, Gerlich, L
Format: Journal Article
Language:English
Published: 01-01-2019
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Summary:OBJECTIVESTo investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fibrillation (AF). BACKGROUNDAF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antagonist oral anticoagulants (NOAC) to warfarin for thromboprophylaxis. Nevertheless, warfarin is still widely used, even if it is challenging, especially in polymorbid elderlies, to achieve the therapeutic international normalised ratio (INR). There are only scarce real-world data on INR in warfarinised elderly AF patients. METHODSThe study was based on multicentric observational Slovak audit of atrial fibrillation in seniors (SAFIS) performed on 4,252 hospitalised AF patients aged over 64 years (mean age 80.9 yrs.). INR data from warfarinised patients were analysed (955 at admission and 870 at discharge). RESULTSAt hospital admission and discharge, the warfarin medication rates were 22.6 % and 23.5 %, respectively, INR lower than 2 was present in 41.8 % and 30.6 % of patients, respectively, and INR higher than 3 was in 27.0 % and 7.7 %, respectively and altogether, 68.8 % and 38.3 % of warfarinised patients, respectively, were out of therapeutic range. CONCLUSIONWarfarin is still frequently used in the elderlies with AF, but the success rates are unsatisfactory in a huge number of patients. It is urgent to improve seniors' access to NOAC (Fig. 2, Ref. 34).
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ISSN:0006-9248
DOI:10.4149/BLL_2019_127