Stroke Prophylaxis in Institutionalized Elderly Patients with Atrial Fibrillation

Abstract

Although warfarin was the most appropriate treatment in nearly all of this population at high risk for stroke, it was prescribed in fewer than two-thirds of patients. Antithrombotic therapy was not always prescribed in accordance with patients' risk factors for stroke and bleeding. There is a need for systematic identification of appropriate candidates for anticoagulation in the long-term care setting.

Underutilization of Warfarin Therapy in Elderly Patients with Atrial Fibrillation ? Fear or False Sense of Security!

“…3 Underutilization of warfarin in elderly is a common problem ranging up to 30-60 % 4,5,6,7,8,9,10,11,12 and is associated with an increased risk of stroke resulting in disability and significant cost.…”

“…Pharmacists run an anticoagulation clinic and adjust the dose of warfarin for all patients as treated. Although under use of warfarin in atrial fibrillation is well recognized, [4][5][6][7][8][9][10][11][12] this study was designed to provide further insight for reasons of warfarin underutilization in the elderly. The electronic medical record of the VA hospital facilitated data base searches to identify subjects for this study.…”

Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients?

“…Robust evidence supports the application of a variety of poststroke interventions for the prevention of recurrent vascular events (e.g., hypertension management) across the spectrum of age groups [3]. Although older patients derive as much, if not more, benefit from acute stroke treatments and prevention strategies (e.g., warfarin and thrombolysis) than younger patients [4][5][6], some studies have found that older stroke patients are less likely to receive interventions than younger patients [7][8][9]. A few studies have examined age disparities in stroke management.…”

"Fibrilação atrial e tratamento antitrombótico em pacientes atendidos em hospital especializado em cardiologia no Brasil"

“…Atualmente, as diretrizes nacionais e internacionais (34,35,36) Contudo, apesar da publicação das diretrizes nacionais e internacionais sedimentadas na medicina baseada em evidências, diversos estudos em todo o mundo têm alertado para o uso excessivamente baixo e inadequado da terapia antitrombótica nos pacientes com fibrilação atrial (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50) . Razões abordadas nestes estudos para justificar tal fato incluem a inconveniência do tratamento pela necessidade de controles laboratoriais seriados, o temor dos médicos pela possibilidade de complicações hemorrágicas, baixa aderência dos pacientes ao tratamento, falta de conhecimento médico com relação às diretrizes existentes e o controle do RNI na maior parte das vezes precário, estando dentro dos níveis preconizados em menos de metade dos pacientes tratados (38)(39)(40)50) .…”

“…Avaliando a incidência de novos eventos embólicos, no período de acompanhamento de um ano do nosso estudo (5,6%), constatamos que esta foi semelhante à descrita na literatura para os pacientes com fibrilação atrial não valvar sem uso de terapia anticoagulante (2,3,(14)(15)(16)(17) . (38,39,41,43,44,47,48,54,55) .…”