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Stroke prevention in elderly patients with atrial fibrillation: challenges for anticoagulation
Author(s) -
Sinnaeve P. R.,
Brueckmann M.,
Clemens A.,
Oldgren J.,
Eikelboom J.,
Healey J. S.
Publication year - 2012
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2011.02464.x
Subject(s) - medicine , atrial fibrillation , dabigatran , antithrombotic , stroke (engine) , intensive care medicine , rivaroxaban , anticoagulant , apixaban , direct thrombin inhibitor , warfarin , cardiology , mechanical engineering , engineering
Sinnaeve PR, Brueckmann M, Clemens A, Oldgren J, Eikelboom J, Healey JS (University Hospitals Leuven, Leuven, Belgium; Global Clinical Development and Medical Affairs, Ingelheim am Rhein, Germany; Uppsala University, Uppsala, Sweden; and Population Health Research Institute, Hamilton, Canada). Stroke prevention in elderly patients with atrial fibrillation: challenges for anticoagulation (Review). J Intern Med 2012; 271 : 15–24. Abstract. Elderly patients with atrial fibrillation (AF), who constitute almost half of all AF patients, are at increased risk of stroke. Anticoagulant therapies, especially vitamin K antagonists (VKA), reduce the risk of stroke in all patients including the elderly but are frequently under‐used in older patients. Failure to initiate VKA in elderly AF patients is related to a number of factors, including the limitations of current therapies and the increased risk for major haemorrhage associated with advanced age and anticoagulation therapy. Of particular concern is the risk of intracranial haemorrhages (ICH), which is associated with high rates of mortality and morbidity. Novel oral anticoagulant agents that are easier to use and might offer similar or better levels of stroke prevention with a similar or reduced risk of bleeding should increase the use of antithrombotic therapy in the management of elderly AF patients. Amongst these new agents, the recently approved direct thrombin inhibitor dabigatran provides effective stroke prevention with a significant reduction of ICH, and enables clinicians to tailor the dose according to age and haemorrhagic risk.