Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review

Pugh, Dan; Pugh, Jack; Mead, Gillian

doi:10.1093/ageing/afr097

Cited by 222 publications

(196 citation statements)

References 27 publications

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“…[7] Two recent systematic reviews emphasised the impact of physicians' apprehension about feeling responsible for a major bleed which seemed to outweigh their concern about risk of stroke. [8,9] This may be related to the Hippocratic Oath to 'first do no harm' [10]: responsibility is attributed to harm perceived to be caused by 'acts of commission', i.e. prescribing OAC, which are not felt with 'acts of omission', i.e., increasing the risk of stroke by not prescribing OAC.…”

Section: Introductionmentioning

confidence: 99%

Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy: A qualitative meta-synthesis

Xuereb

Shaw

Lane

2012

Patient Education and Counseling

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Section: Introductionmentioning

confidence: 99%

Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy: A qualitative meta-synthesis

Xuereb

Shaw

Lane

2012

Patient Education and Counseling

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“…Although age is significantly associated with a high risk of stroke [41], old age itself is negatively associated with anticoagulant prescription [42]. Advanced age per se, physician's perceived high risk of age-related and fall-related bleeding, and difficulties in monitoring warfarin-based anticoagulant therapy have been reported among the main factors accounting for underprescription of anticoagulant therapy in older patients with AF [41,[43][44][45]. Although several studies suggest that advanced age itself should not prevent prescription of oral anticoagulants in the elderly patients [46][47][48], under-prescription of anticoagulants among the oldest patients remains a common clinical practice in several contemporary medical settings [15,45].…”

Section: Dabigatran In the Elderly Elderly Atrial Fibrillation And Amentioning

confidence: 99%

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

Molteni

Minno

et al. 2017

Intern Emerg Med

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Dabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney disease (CKD) are per se at high risk of stroke, bleeding and mortality. Although there is evidence of clinical benefit of anticoagulation in these patients, anticoagulant therapy requires caution and demands careful clinical monitoring, regardless of the drug used. In patients with no contraindication to its use, the clinical benefit of DE versus warfarin is independent of renal function. The elderly with AF are frequently undertreated because of the perception of high bleeding risk and limited clinical benefit. However, the clinical benefit of anticoagulation is independent of patient age, and age per se should not represent a contraindication to anticoagulation. DE has been extensively studied in the elderly, both in randomized clinical trials and in observational studies: DE 150 mg BID should not be used in patients 80 years of age or older, while DE 110 mg BID is as safe as warfarin. Intracranial haemorrhages reduction by DE compared with warfarin is preserved in the elderly. Therefore, mild and moderate CKD and being elderly should not deter physicians from prescribing DE. Furthermore, the availability of a specific antidote is expected to improve the safety of the use of DE in clinical practice.

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“…Следует отметить, что врачи в недостаточной степени следуют рекомендациям по ведению пожилых паци-ентов с ФП, особенно старше 70 лет и/или с поли-морбидностью, что обусловлено страхом перед высо-ким риском кровотечения, падений, последствий ле-карственных взаимодействий и других потенциальных осложнений, в том числе связанных с «хрупкостью», на-рушением когнтивных функций и низкой привержен-ностью пациентов лечению [61].…”

Section: Antithrombotic Therapy In Elderly Patients With Atrial Fibriunclassified

“…В реальной практике антикоагулянты получают ме-нее половины пациентов, отвечающих критериям про-ведения антикоагулянтной терапии [35,61,62]. При этом результаты целенаправленных исследований свиде-тельствуют, что пожилой и старческий возраст не яв-ляется абсолютным противопоказанием к проведению пероральной антикоагулянтной терапии [63,64].…”

Section: Antithrombotic Therapy In Elderly Patients With Atrial Fibriunclassified

Approaches to Antithrombotic Therapy in Elderly Patients With Atrial Fibrillation

Ушкалова

Zyryanov

Dumchenko

2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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Российский университет дружбы народов. Россия 117198, Москва, ул. Миклухо-Маклая, 6Пожилой возраст -наиболее важный и независимый фактор риска развития фибрилляции предсердий (ФП). Доля больных с ФП в воз-расте 65-85 лет достигает 70%, а средний возраст пациентов с ФП составляет 75 лет. Антитромботическая терапия у пожилых затруднена в силу ряда причин. С одной стороны, у пожилых повышен риск развития системной эмболии и инсульта, а также фатальных исходов ин-сульта по сравнению с более молодыми пациентами. С другой стороны, у пожилых пациентов повышен риск кровотечений. Кроме того, они страдают сопутствующими заболеваниями и получают препараты, которые могут вступать во взаимодействия с антитромботическими сред-ствами. В статье обсуждаются шкалы, применяемые для оценки риска тромбоэмболических и геморрагических осложнений и общие под-ходы к антитромботической терапии у пожилых пациентов. Advanced age is the most important and independent risk factor for the development of atrial fibrillation (AF). The proportion of patients with AF at the age of 65-85 years reaches 70%, and average age of patients with AF is 75 years. Antithrombotic therapy of AF in the elderly is challenging for several reasons. On the one hand, elderly patients are at an increased risk of systemic embolism and stroke and fatal outcomes of stroke are higher in the elderly compared with these in the younger patients. On the other hand, elderlies are at an increased risk of bleeding. In addition, they have important comorbidities and are treated with drugs that can interact with antithrombotic agents. The article discusses tools used to assess risks of thromboembolic and hemorrhagic complications and general approaches to antithrombotic treatment of elderly patients.Keywords: antithrombotic therapy, atrial fibrillation, elderly, assessment of risk of thromboembolic and hemorrhagic complications. АКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИ ВведениеФибрилляция предсердий (ФП) -самый часто встречающийся вид сердечной аритмии, распростра-ненность которой значительно увеличивается с воз-растом. Согласно данным эпидемиологических ис-следований у лиц старше 80 лет она достигает 15-20% по сравнению с <0,1% у лиц моложе 40 лет [1,2]. Воз-можно, что реальная распространенность ФП еще выше, так как методы, применяемые в эпидемиологи-ческих исследованиях, недостаточно выявляют паро-ксизмальную форму ФП [3].По данным Фремингемского исследования рас-пространенность и частота ФП удваиваются каждое де-сятилетие после 50 лет [4]. Например, среди мужчин 75-79 лет распространенность ФП в 2 раза превыша-ет таковую среди мужчин в возрасте 65-69 лет и в 5 раз -в возрасте 55-59 лет [5]. Доля лиц 65-85 лет среди пациентов c ФП достигает 70%, а средний возраст боль-ных составляет 75 лет [6,7]. В связи с постарением на-селения встречаемость ФП продолжает расти -если в 1990 г. она составляла в мире 60,7 на 100000 чело-веко-лет среди мужчин и 43,8 -среди женщин, то в

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Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review

Cited by 222 publications

References 27 publications

Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy: A qualitative meta-synthesis

Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy: A qualitative meta-synthesis

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

Approaches to Antithrombotic Therapy in Elderly Patients With Atrial Fibrillation

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