Oral anticoagulation in patients with atrial fibrillation and medical non-neoplastic disease in a terminal stage

Abstract

Many patients with non-neoplastic disease develop atrial fibrillation in advanced stages of their disease. The aim of this study is to determine the factors associated with the use of oral anticoagulants in patients with atrial fibrillation and non-neoplastic medical disease in a terminal stage, and whether their use is associated with a longer survival. Design is prospective, observational, multicentre study. Patients with atrial fibrillation and non-neoplastic disease (severe not reversible organ insufficiency) in a terminal stage were included between February 2009 and September 2010. A 6-month follow-up was carried out. We included 314 patients with a mean (SD) age of 82.6 (7.0) years. Their mean (SD) scores in CHADS2 and ATRIA scales were 3.4 (1.2) and 4.7 (2.0), respectively. Anticoagulants were prescribed to 112 (37.5 %) patients. The use of anticoagulants was associated with age (OR 0.96 95 % CI 0.93-0.99, p = 0.046) and to the Barthel index (OR 1.01 95 % CI 1.00-1.02; p = 0.034). After performing a propensity score matching analysis, 262 patients were included in the survival analysis. After 6 months, 133 (50.8 %) patients were dead. The mortality is higher among patients who are not treated with oral anticoagulants (57.1 vs. 39.4 %; p = 0.006), but it is independently associated only with the Barthel index score (HR 0.99 95 % CI 0.98-1.00; p = 0.039), delirium (HR 1.60, 95 % CI 1.08-2.36; p = 0.018), anorexia (HR 1.58 95 % CI 1.05-2.38; p = 0.027), and with the use of calcium channel blockers (HR 0.50 95 % CI 0.30-0.84; p = 0.009). In patients with atrial fibrillation and non-neoplastic disease in a terminal stage, the use of oral anticoagulants is not independently associated with a higher probability of survival.

Delirium risk factors in hospitalized patient: a comprehensive evaluation of underlying diseases and medications in different wards of a large Urban Hospital Center in Iran

“…So, we investigated the role of a wide range of prescribed drugs for developing delirium. Anticoagulants (warfarin, heparin, enoxaparin) reduced the chances of developing delirium, similar to a previous study by Diez-Manglano et al [ 41 ] which found anticoagulants to be associated with lower delirium prevalence in patients with atrial fibrillation. Nevertheless, Lahariya et al [ 42 ] reported an increase in delirium risk by receiving warfarin in patients admitted to a cardiac intensive care unit, while Ranhoff et al [ 43 ] found no relation between warfarin use and the risk of delirium.…”

Survival of Frail Elderly with Delirium

“…The strength of the lower limbs measured by the sit and stand up test is a biomarker of disease severity [ 61 ] that is partly due to malnutrition and a lack of exercise [ 62 ]. These factors contribute to ageing adverse events, such as falls, which can produce head trauma that increases mortality in older patients with anticoagulant pharmacy [ 63 ], a known risk for older people [ 64 ]. Readmission before 30 days of discharge should be considered as another frailty indicator, but has not often been recognized as such.…”

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

“…However, a poorer cognitive state was associated with not starting OA therapy. In fact, the ability to carry out basic activities of daily living has been a determinant of survival in polypathological patients or those with advanced disease with NVAF …”

“…In fact, the ability to carry out basic activities of daily living has been a determinant of survival in polypathological patients or those with advanced disease with NVAF. 25,28 Within 18 months, 25-30% of the patients with NVAF discontinued OA therapy. 29 The discontinuation of OA for patients with NVAF has not improved with the new direct-acting OA, 30 and has been associated with younger age, anemia, bleeding, frailty, low life expectancy, hospitalizations and emergency department visits.…”