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Archivos de cardiología de México
On-line version ISSN 1665-1731Print version ISSN 1405-9940
Abstract
RAMIREZ-PRIETO, Génesis; POMBO-BARTELT, José E.; ROJAS-CALDERON, Guadalupe and GARCIA-GONZALEZ, José J.. Prescription of oral anticoagulation in geriatric patients with atrial fibrillation. Arch. Cardiol. Méx. [online]. 2022, vol.92, n.1, pp.42-52. Epub Feb 07, 2022. ISSN 1665-1731. https://doi.org/10.24875/acm.20000563.
Objective:
To determine the prevalence of prescription of oral anticoagulation in patients aged > 60 years with nonvalvular atrial fibrillation (NVAF).
Methods:
Observational, cross-sectional, retrospective study based on a review of the clinical histories of patients aged >60 years diagnosed with NVAF from July 1 to September 30, 2019 and seen at the outpatient clinic (cardiology, internal medicine, geriatrics) of a secondary-level hospital in Queretaro, Mexico. Clinical profile and oral anticoagulant treatment were analyzed.
Results:
The study population comprised 300 patients (mean age, 77.2±8.3 years; 53.3% women; 81% attended in cardiology). Of these, 91% had a high thromboembolic risk, 22.7% a high bleeding risk, and 1.7% contraindications for anticoagulation. Comorbidity was frequent. As for therapy, 82.7% were taking direct oral anticoagulants (DOAC), 11.0% vitamin K antagonists (VKA), and 6.3% no anticoagulant treatment. Anticoagulant therapy was inappropriate in 29.3% of patients, mainly because DOAC were prescribed without adjusting for age, weight, or serum creatinine and administered without indication according to thromboembolic risk. Only 39.4% of patients taking VKA were within the therapeutic range. Of all patients receiving DOAC, 48.0% were taking rivaroxaban, mainly at 20 mg/d (73.1%).
Conclusions:
Thromboembolic risk is high in geriatric patients with NVAF. Anticoagulation is contraindicated in <2% of patients. Oral anticoagulants are prescribed inappropriately in three out of ten patients.
Keywords : Geriatric; Vitamin K antagonists; Anticoagulation; Direct oral anticoagulants; Atrial fibrillation.