Korean Circ J.  2018 Oct;48(10):873-889. 10.4070/kcj.2018.0261.

Anticoagulation for Stroke Prevention in Older Adults with Atrial Fibrillation and Comorbidity: Current Evidence and Treatment Challenges

Affiliations
  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. noseworthy.peter@mayo.edu
  • 2Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.

Abstract

The burden of atrial fibrillation (AF) is projected to increase substantially over the next decade in parallel with the aging of the population. The increasing age, level of comorbidity, and polypharmacy will complicate the treatment of older adults with AF. For instance, advanced age and chronic kidney disease have been shown to increase the risk of both thromboembolism and bleeding in patients with AF. Frailty, recurrent falls and polypharmacy, while very common among elderly patients with AF, are often overlooked in the clinical decision making despite their significant interaction with oral anticoagulant (OAC) and profound impact on the patient's clinical outcomes. Such factors should be recognized, evaluated and considered in a comprehensive decision-making process. The introduction of non-vitamin K oral anticoagulants has radically changed the management of AF allowing for a more individualized selection of OAC. An understanding of the available data regarding the performance of each of the available OAC in a variety of at risk patient populations is paramount for the safe and effective management of this patient population. The aim of this review is to appraise the current evidence, point out the gaps in knowledge, and provide recommendations regarding stroke prevention in older adults with AF and comorbid conditions.

Keyword

Frailty; Warfarin; NOAC; Stroke; Bleeding

MeSH Terms

Accidental Falls
Adult*
Aged
Aging
Anticoagulants
Atrial Fibrillation*
Clinical Decision-Making
Comorbidity*
Hemorrhage
Humans
Polypharmacy
Renal Insufficiency, Chronic
Stroke*
Thromboembolism
Warfarin
Anticoagulants
Warfarin

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