Target specific oral anticoagulants in the management of thromboembolic disease in the elderly

2013 ◽  
Vol 36 (2) ◽  
pp. 203-211 ◽  
Author(s):  
Surekha Maddula ◽  
Jack Ansell
Keyword(s):  
Oral Anticoagulants ◽  
The Elderly ◽  
Thromboembolic Disease

P530: The oral anticoagulants in thromboembolic disease in the elderly. About 300 cases

2014 ◽  
Vol 5 ◽  
pp. S250-S251
Author(s):  
A. Laanani ◽  
I. Ben Ghorbel ◽  
M.E.D. Mejri ◽  
T. Ben Salem ◽  
F. Said ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
The Elderly ◽  
Thromboembolic Disease

scholarly journals Net clinical benefit of anticoagulation therapy in the elderly patients with atrial fibrillation

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Lorenzo Palleschi ◽  
Eleonora Nunziata
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Clinical Decision Making ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Clinical Decision ◽  
The Elderly ◽  
Thromboembolic Disease ◽  
Net Clinical Benefit

Old age remains one of the strongest risk factors for stroke in patients with atrial fibrillation (AF). Oral anticoagulation (OAC) is the most effective way to prevent thromboembolic disease in patients with atrial fibrillation (AF). Until few years ago, aspirin and vitamin-K antagonists (VKAs) were the primary agents used to prevent thromboembolic disease in patients with AF. The approval of non–vitamin K oral anticoagulants (NOACs) has now expanded the range of therapeutic agents available to providers. The authors highlight practical considerations regarding the selection and use of OAC in older adults to aid clinical decision making.

scholarly journals Stroke Prevention: Little-Known and Neglected Aspects

2021 ◽  
pp. 1-14
Author(s):  
M. Reza Azarpazhooh ◽  
Chrysi Bogiatzi ◽  
J. David Spence
Keyword(s):  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Blood Pressure Reduction ◽  
The Elderly ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Enteric Coating ◽  
Asymptomatic Carotid ◽  
Lowering Therapy ◽  
Direct Acting

Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoiding excessive blood pressure reduction in patients with stiff arteries; (8) treatment of insulin resistance with pioglitazone in stroke patients with prediabetes and diabetes; (9) impaired activation of clopidogrel in patients with variants of CYP2C19; (10) aspirin pseudoresistance due to enteric coating; (11) rationale for anticoagulation in patients with embolic stroke of unknown source; (12) pharmacologic properties of direct-acting oral anticoagulants that should be considered when choosing among them; (13) the identification of which patients with asymptomatic carotid stenosis are at a high enough risk to benefit from carotid endarterectomy or stenting; and (14) the importance of age in choosing between endarterectomy and stenting. Stroke prevention could be improved by better recognition of these issues and by implementation of the principles derived from them.

scholarly journals Prescription of oral anticoagulants and antiplatelets for stroke prophylaxis in atrial fibrillation: nationwide time series ecological analysis

EP Europace ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. 1311-1319 ◽  
Author(s):  
Jianhua Wu ◽  
Eman S Alsaeed ◽  
James Barrett ◽  
Marlous Hall ◽  
Campbell Cowan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Antiplatelet Agents ◽  
The Elderly ◽  
Early Years ◽  
Prescription Data ◽  
Ecological Analysis ◽  
General Practices

Abstract Aims To investigate trends in the prescription of oral anticoagulants (OACs) and antiplatelet agents for atrial fibrillation (AF). Methods and results Prescription data for 450 518 patients with AF from 3352 General Practices in England, was obtained from the GRASP-AF registry, 2009–2018. Annualized temporal trends for OAC and antiplatelet prescription were reported according to eligibility based on stroke risk (CHADS2 or CHA2DS2-VASc scores ≥1 or >2, respectively). From 2009 to 2018, the prevalence of AF increased from 1.6% [95% confidence interval (CI) 1.5–1.7%] to 2.4% (2.3–2.5%), and for those with AF the proportion prescribed OAC increased from 47.6% to 75.0% (P-trend < 0.001; relative risk 1.57, 95% CI 1.55–1.60) and for antiplatelet decreased from 37.4% to 9.2% (P-trend < 0.001). In early-years (2009–2013), eligible patients aged ≥80 years were less likely to be prescribed OAC than patients aged <80 years [odds ratio (OR) 0.55, 95% CI 0.51–0.59 for CHADS2≥1 in 2009] (all P-trends < 0.001). This ‘OAC prescription gap’ reduced over the study period (OR 0.93, 0.90–0.96 in 2018). Whilst the prescription of direct oral anticoagulant (DOAC) as a proportion of all OAC increased from 0.1% (95% CI 0.0–0.2%) in 2011 to 58.8% (58.4–59.2%) in 2018, it was inversely associated with patient age (P-trend < 0.001) and their risk of stroke. Conclusion Between 2009 and 2018, in England, the use of OAC for stroke prophylaxis in AF increased, with DOAC accounting for over half of OAC uptake in 2018. Despite a reduction in the OAC-prescription gap, a new paradox exists relating to DOAC prescription for the elderly and those at higher risk of stroke.

Optimizing the Use of Anticoagulants (Heparins and Oral Anticoagulants) in the Elderly

Drugs & Aging ◽  
2013 ◽  
Vol 30 (9) ◽  
pp. 687-699 ◽  
Author(s):  
Virginie Siguret ◽  
Isabelle Gouin-Thibault ◽  
Pascale Gaussem ◽  
Eric Pautas
Keyword(s):  
Oral Anticoagulants ◽  
The Elderly

scholarly journals Use of direct oral anticoagulants in thromboembolic disease

Prescriber ◽  
2016 ◽  
Vol 27 (8) ◽  
pp. 15-22 ◽  
Author(s):  
Matthew R Wilson ◽  
Kieran F Docherty ◽  
Roy S Gardner
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Thromboembolic Disease
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