Anticoagulant therapy in elderly patients and cardiac implantable electronic devices

2020 ◽  
Vol 2 (55) ◽  
pp. 29-34
Author(s):  
Marcin Wełnicki ◽  
Aleksandra Kurek ◽  
Zuzanna Stemplewska
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Perioperative Complications ◽  
Electronic Devices ◽  
Anticoagulation Therapy ◽  
Review Article ◽  
Anticoagulation Treatment ◽  
Cardiac Implantable Electronic Devices

The number of implantations of cardiac implantable electronic devices (CIED), as well as the prevalence of atrial fibrillation (AF), is on the rise as the population ages. At the same time, regardless of the need for CIED implantation, many elderly patients require long-term anticoagulation therapy to prevent stroke. Those patients are considered a group of higher risk of perioperative complications of CIED implantation. This review article provides a summary of the indications, possibilities, and challenges of anticoagulation treatment in elderly patients with indications for CIED implantation.

scholarly journals Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (25) ◽  
Author(s):  
Peter A. Noseworthy ◽  
Elizabeth S. Kaufman ◽  
Lin Y. Chen ◽  
Mina K. Chung ◽  
Mitchell S.V. Elkind ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
American Heart ◽  
Electronic Devices ◽  
Heart Association ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
Scientific Statement ◽  
Existing Data

The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.

scholarly journals Outpatient Management of Oral Anticoagulation Therapy in Patients with Nonvalvular Atrial Fibrillation

2009 ◽  
Vol 9 (4) ◽  
pp. 313-319 ◽  
Author(s):  
Aida Kulo ◽  
Nedžad Mulabegović ◽  
Jasna Kusturica ◽  
Hasija Hadžić ◽  
Lejla Burnazović-Ristić ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Dose Titration ◽  
Nonvalvular Atrial Fibrillation ◽  
Annual Dose ◽  
Oral Anticoagulation Therapy ◽  
Anticoagulation Treatment ◽  
One Year

Due to heightened risk for thromboembolic complications, nonvalvular atrial fibrillation (NVAF) presents an absolute indication for long-term oral anticoagulation therapy. This was an observational, analytical, randomised, one-year clinical study, conducted in the Blood Transfusion Institute Sarajevo, Bosnia & Herzegovina. The aim of this study was to present the oral anticoagulation treatment in terms of International normalised ratio (INR) monitoring and warfarin/acenocoumarol dose titration in 117 patients with NVAF. INR values, the doses of warfarin and acenocoumarol, as well as the tendency and adequacy of their changes were monitored. Percentages of the therapeutic INR values were 51,77% and 53,62%, subtherapeutic 42,84% and 35,86%, and supratherapeutic 5,39% and 10,53% for the warfarin and acenocoumarol treatment, respectively. The average total weekly doses (TWD) which most frequently achieved the therapeutic INR values were 27,89±12,34 mg and 20,44±9,94 mg, for warfarin and aceno- coumarol, respectively. The dose changes with the INR values 1,7 or lower/3,3 or higher were omitted in 13,46% and 15,63%, and with the INR values 1,8-3,2 were noted in 8,62% and 13,48% of all the check-up visits in the warfarin and acenocoumarol group, respectively. The annual dose changes were noted in 24,65% and 31,41%, and the daily dose changes in 74,43% and 73,36% of all the check-up visits of warfarin and acenocoumarol group, respectively. We can conclude that the management of the oral anticoagulation treatment in our country is in accordance with the relevant recommendations, but with the present tendency toward underdosing and unnecessary frequent dose changing.

scholarly journals Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices

Medicine ◽  
2016 ◽  
Vol 95 (28) ◽  
pp. e4181 ◽  
Author(s):  
Bum Sung Kim ◽  
Kwang Jin Chun ◽  
Jin kyung Hwang ◽  
Seung-Jung Park ◽  
Kyoung-Min Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Electronic Devices ◽  
Cardiac Implantable Electronic Devices

Frailty Status Affects the Decision for Long-Term Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation

Drugs & Aging ◽  
2018 ◽  
Vol 35 (10) ◽  
pp. 897-905 ◽  
Author(s):  
Panteleimon E. Papakonstantinou ◽  
Natalia I. Asimakopoulou ◽  
John A. Papadakis ◽  
Dimitrios Leventis ◽  
Michail Panousieris ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Anticoagulation Therapy ◽  
Frailty Status

scholarly journals Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

2017 ◽  
Vol 3 (2) ◽  
Author(s):  
Francesco Vetta ◽  
Gabriella Locorotondo ◽  
Giampaolo Vetta
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
The Elderly ◽  
Hemorrhagic Events

Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive assessment, besides the scores addressing risk of thromboembolic and hemorrhagic events. In the meantime, it is mandatory that use of anticoagulant therapy in most elderly people, currently excluded from randomized controlled trials, is prudent and responsible.

Abstract 14790: Prospective Evaluation of the Effect of Smartphone Electrocardiogram Usage on Anticoagulant Medication Compliance: Results of the Better Outcomes of Anticoagulation Therapy by Observation of Atrial Rhythm (BOAT OART) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanjaya K Gupta ◽  
Andy T Tran ◽  
Daniel Steinhaus ◽  
Omair Yousuf ◽  
Michael Giocondo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Compliance ◽  
Anticoagulation Therapy ◽  
Control Group ◽  
Anticoagulation Treatment ◽  
Improve Compliance ◽  
And Control ◽  
Anticoagulant Medication ◽  
Monitor Group

Introduction: Compliance with anticoagulation treatment for atrial fibrillation is variable. Smartphone electrocardiograms that provide accurate arrhythmia diagnosis may allow patients to have greater insight into their arrhythmia burden. Hypothesis: Our hypothesis was that regular use of a smartphone electrocardiogram would improve anticoagulant compliance. Methods: Patients were enrolled if they had atrial fibrillation with a CHA2DS2-VASc score of 2 or more, were eligible for anticoagulation and had a smartphone. Participants were randomly assigned to receive a smartphone electrocardiogram (AliveCor Kardia) or to the control group. All patients received 6 months of anticoagulant (apixaban) dispensed as 1-month pre-loaded pill boxes. Patients returned monthly to assess medication compliance and receive subsequent month medication. Monitor patients were encouraged to record their electrocardiogram 5 times a week. Results: A total of 100 patients were enrolled from July 2017 to August 2019, but 4 patients in the monitor arm withdrew prematurely. The monitor and control groups did not differ in age, gender, CHA2DS2-VASc score, comorbidities or atrial fibrillation burden. Medication compliance was 99.1%, with greater compliance in the monitor group (99.5 ± 0.86%) than the control group (98.8% ± 2.19%; p=0.03). In the monitor group, there was no association between missed doses and use or nonuse of the smartphone monitor on a given day. Overall monitor compliance was 87.0±14% with an average of 4.35 recorded electrocardiograms per week. Monitor group patients with 100% medication compliance had a higher average monitor compliance than those patients who missed doses (90.3±11% vs 83.5±15.8%; p=0.05). There were no major adverse events related to anticoagulation. Conclusions: Despite excellent overall anticoagulant medication compliance, this study indicates that smartphone electrocardiogram usage is associated with higher medication compliance. Greater monitor compliance was also associated with greater medication compliance. Future studies are necessary to determine if smartphone electrocardiograms can be used to maintain anticoagulant compliance long-term or improve compliance at onset of anticoagulation treatment.

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