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BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2015

Open Access 01-12-2015 | Debate

Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach

Authors: Carmen Suárez Fernández, Francesc Formiga, Miguel Camafort, Jose María Cepeda Rodrigo, Jesús Díez-Manglano, Antonio Pose Reino, Gregorio Tiberio, Jose María Mostaza, on behalf of Grupo de trabajo de Riesgo vascular de la SEMI

Published in: BMC Cardiovascular Disorders | Issue 1/2015

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Abstract

Background

Atrial fibrillation (AF) in the elderly is a complex condition. It has a direct impact on the underuse of antithrombotic therapy reported in this population.

Discussion

All patients aged ≥75 years with AF have an individual yearly risk of stroke >4 %. However, the risk of hemorrhage is also increased. Moreover, in this population it is common the presence of other comorbidities, cognitive disorders, risk of falls and polymedication. This may lead to an underuse of anticoagulant therapy. Direct oral anticoagulants (DOACs) are at least as effective as conventional therapy, but with lesser risk of intracranial hemorrhage. The simplification of treatment with these drugs may be an advantage in patients with cognitive impairment.
The great majority of elderly patients with AF should receive anticoagulant therapy, unless an unequivocal contraindication. DOACs may be the drugs of choice in many elderly patients with AF.

Summary

In this manuscript, the available evidence about the management of anticoagulation in elderly patients with AF is reviewed. In addition, specific practical recommendations about different controversial issues (i.e. patients with anemia, thrombocytopenia, risk of gastrointestinal bleeding, renal dysfunction, cognitive impairment, risk of falls, polymedication, frailty, etc.) are provided.
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Metadata
Title
Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach
Authors
Carmen Suárez Fernández
Francesc Formiga
Miguel Camafort
Jose María Cepeda Rodrigo
Jesús Díez-Manglano
Antonio Pose Reino
Gregorio Tiberio
Jose María Mostaza
on behalf of Grupo de trabajo de Riesgo vascular de la SEMI
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2015
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-015-0137-7

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