Traditional thromboprophylaxis in elderlies with atrial fibrillation: What we can achieve in real life

Abstract

OBJECTIVES: To investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fi brillation (AF). BACKGROUND: AF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antagonist oral anticoagulants (NOAC) to warfarin for thromboprophylaxis. Nevertheless, warfarin is still widely used, even if it is challenging, especially in polymorbid elderlies, to achieve the therapeutic international normalised ratio (INR). There are only scarce real-world data on INR in warfarinised elderly AF patients. METHODS: The study was based on multicentric observational Slovak audit of atrial fi brillation in seniors (SAFIS) performed on 4,252 hospitalised AF patients aged over 64 years (mean age 80.9 yrs.). INR data from warfarinised patients were analysed (955 at admission and 870 at discharge). RESULTS: At hospital admission and discharge, the warfarin medication rates were 22.6 % and 23.5 %, respectively, INR lower than 2 was present in 41.8 % and 30.6 % of patients, respectively, and INR higher than 3 was in 27.0 % and 7.7 %, respectively and altogether, 68.8 % and 38.3 % of warfarinised patients, respectively, were out of therapeutic range. CONCLUSION: Warfarin is still frequently used in the elderlies with AF, but the success rates are unsatisfactory in a huge number of patients. It is urgent to improve seniors' access to NOAC (Fig. 2, Ref. 34).

Concentration of apelin inversely correlates with atrial fibrillation burden

“…Atrial fi brillation (AF) is one of the most common heart conditions affecting approximately 3 % of adult population over 20 years with even greater prevalence among older patients and patients with chronic conditions. It is an independent risk factor associated with a higher risk of stroke (1), increased mortality twice-fold in women and 1.5-fold in men (2). One of the main challenges is AF detection since it can be asymptomatic and diagnostic capacity of standard ECG monitoring is limited (3,4).…”

Plasmatic apelin shows a promising potential as a screening biomarker for atrial fibrillation

“…As an independent risk factor, AF increases mortality two-fold in women and 1.5-fold in men and 5-fold the risk of ischemic stroke (2,6). Appropriate therapy signifi cantly reduces these risks; however, it must be preceded by correct and timely diagnosis (6)(7)(8).…”