Anticoagulation for stroke prevention in older adults with atrial fibrillation and comorbidity: Current evidence and treatment challenges

Avi Sabbag, Xiaoxi Yao, Konstantinos C. Siontis, Peter A. Noseworthy

Research output: Contribution to journalReview article

4 Scopus citations

Abstract

The burden of atrial fibrillation (AF) is projected to increase substantially over the next decade in parallel with the aging of the population. The increasing age, level of comorbidity, and polypharmacy will complicate the treatment of older adults with AF. For instance, advanced age and chronic kidney disease have been shown to increase the risk of both thromboembolism and bleeding in patients with AF. Frailty, recurrent falls and polypharmacy, while very common among elderly patients with AF, are often overlooked in the clinical decision making despite their significant interaction with oral anticoagulant (OAC) and profound impact on the patient's clinical outcomes. Such factors should be recognized, evaluated and considered in a comprehensive decision-making process. The introduction of non-vitamin K oral anticoagulants has radically changed the management of AF allowing for a more individualized selection of OAC. An understanding of the available data regarding the performance of each of the available OAC in a variety of at risk patient populations is paramount for the safe and effective management of this patient population. The aim of this review is to appraise the current evidence, point out the gaps in knowledge, and provide recommendations regarding stroke prevention in older adults with AF and comorbid conditions.

Original languageEnglish (US)
Pages (from-to)873-889
Number of pages17
JournalKorean Circulation Journal
Volume48
Issue number10
DOIs
StatePublished - Oct 2018

Keywords

  • Bleeding
  • Frailty
  • NOAC
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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