Treatment of very old patients with non valvular atrial fibrillation. The valuable opportunity offered by New Oral Anticoagulants, to be cautiously used

  • Francesco Orso SOD Cardiologia e Medicina Geriatrica, Firenze, Italy.
  • Riccardo Barucci SOD Cardiologia e Medicina Geriatrica, Firenze, Italy.
  • Stefania Fracchia SOD Cardiologia e Medicina Geriatrica, Firenze, Italy.
  • Giulio Mannarino SOD Cardiologia e Medicina Geriatrica, Firenze, Italy.
  • Alessandra Pratesi SOD Cardiologia e Medicina Geriatrica, Firenze, Italy.
  • Francesco Fattirolli | francesco.fattirolli@unifi.it SOD Riabilitazione Cardiologica, Firenze, Italy.

Abstract

Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia and its incidence increases with age reaching a 10% prevalence in the oldest old. Patients with AF have a five-fold increase in the risk of stroke. Current guidelines on AF management recommend the prescription of oral anticoagulant therapy in patients at medium and high risk of thromboembolic events. Advanced age is a risk factor for stroke in AF, but despite clear evidences a high rate of OAT under prescription is reported and particularly in the oldest old. Among the main causes of this phenomenon an enhanced risk of bleeding is often reported: this due to several factors: risk of falls, the presence of comorbidity and polifarmacy and a reduction in compliance and adherence that are common in the elderly. In recent years the international scenario in the management of OAT has significantly changed since the introduction of the new oral anticoagulants (NOA): Dabigatran, a direct thrombin inhibitor, and two oral factor Xa inhibitors Rivaroxaban and Apixaban, which have all been tested in randomized clinical trial (RELY, ROCKET-AF e ARISTOTLE) which have demonstrated non inferiority compared to warfarin in the prevention of thromboembolic events with an optimal safety profile. NOA could be an important therapeutic opportunity for stroke prevention in elderly patients with AF even if the substantial differences in mean age, anthropometric measures and comorbidity of the patients enrolled in these trials compared with those of the real world setting, oblige some caution and discussion.

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Published
2013-12-30
Info
Issue
Section
Reviews
Keywords:
Atrial fibrillation, new oral anticoagulants, warfarin, stroke, thromboembolic events, elderly.
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How to Cite
Orso, F., Barucci, R., Fracchia, S., Mannarino, G., Pratesi, A., & Fattirolli, F. (2013). Treatment of very old patients with non valvular atrial fibrillation. The valuable opportunity offered by New Oral Anticoagulants, to be cautiously used. Monaldi Archives for Chest Disease, 80(4). https://doi.org/10.4081/monaldi.2013.17