Anticoagulation for Stroke Prevention in Older Adults with Atrial Fibrillation and Comorbidity: Current Evidence and Treatment Challenges
Korean Circulation Journal
; : 873-889, 2018.
Article
in English
| WPRIM (Western Pacific)
| ID: wpr-738653
Responsible library:
WPRO
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.
Full text:
Available
Health context:
Sustainable Health Agenda for the Americas
/
SDG3 - Health and Well-Being
Health problem:
Goal 9: Noncommunicable diseases and mental health
/
Target 3.4: Reduce premature mortality due to noncommunicable diseases
Database:
WPRIM (Western Pacific)
Main subject:
Atrial Fibrillation
/
Thromboembolism
/
Warfarin
/
Accidental Falls
/
Aging
/
Comorbidity
/
Polypharmacy
/
Stroke
/
Renal Insufficiency, Chronic
/
Clinical Decision-Making
Type of study:
Practice guideline
/
Prognostic study
Aspects:
Implementation research
Limits:
Adult
/
Aged
/
Humans
Language:
English
Journal:
Korean Circulation Journal
Year:
2018
Document type:
Article