An Elderly Patient with Atrial Fibrillation: Ways to Enhance Safety of Anticoagulant Therapy
Purpose. To discuss the possibility of using an oral direct-acting anticoagulant, apixaban, to prevent stroke and/or systemic embolism in elderly patients with atrial fibrillation.
Key Points. In addition to the high risk of stroke and haemorrhage, elderly patients have some characteristics (e.g. multimorbidy and senile asthenia syndrome) which should be taken into account when prescribing anticoagulants. Apixaban efficiency and safety in elderly patients with atrial fibrillation were studied during ARISTOTLE trial subanalysis. The article describes the results of two recent retrospective observational studies which confirmed positive profile of apixaban efficiency and safety in elderly patients in clinical practice. The data from ARISTOTLE trial subanalysis regarding apixaban efficiency and safety in patients with only one out of three criteria for apixaban dose reduction or multimorbidy were discussed. Also, FORTA consensus document is discussed which specifies the individual approach to management of elderly patients on the basis of clinical characteristics. First Russian recommendations about senile asthenia are mentioned, including restricted prescription of anticoagulants to elderly patients with senile asthenia.
Conclusion. A full dose of apixaban (5 mg twice daily) is absolutely efficient and safe for patients with multimorbidy or only one criterion for apixaban dose reduction. According to FORTA experts, apixaban is a FORTA-A class drug and is the safest oral anticoagulant for elderly patients. Senile asthenia is not a contraindication for anticoagulant therapy and not a reason to reduce an anticoagulant dose.
Contribution: Vorobyeva, N.M. — concept, manuscript preparation, review of critically important material; Tkacheva, O.N. — concept, final approval of the manuscript for publication.
Conflict of interests: The article was prepared with the support from Pfizer, but it has in no way affected the author’s opinion.
N.M. Vorobyeva — Russian Clinical Research Center for Gerontology (a Standalone Unit of the N.I. Pirogov Russian National Research Medical University, a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 16 Pervaya Leonova St., Moscow, Russian Federation 129226. E-mail: email@example.com
O.N. Tkacheva — Russian Clinical Research Center for Gerontology (a Standalone Unit of the N.I. Pirogov Russian National Research Medical University, a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 16 Pervaya Leonova St., Moscow, Russian Federation 129226. E-mail: firstname.lastname@example.org
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