ORAL COMMUNICATION | Patterns of anticoagulant therapy in a cohort of very elderly patients with atrial fibrillation

[Pattern prescrittivi della terapia anticoagulante in una coorte di pazienti grandi anziani con fibrillazione atriale]

Introduction. Anticoagulant therapy (AC) in frail elderly patients with atrial fibrillation (AF) presents a challenge due to the complex balance between thromboembolic and haemorrhagic risk.

Materials and Methods. In a retrospective study, we analysed AC prescribing patterns in 83 patients aged ≥ 85 years admitted with AF to our department. Demographic, clinical, and laboratory variables, as well as geriatric assessment scales (NEWS, IDA, BRADEN, MORSE), were investigated. Patients were divided into two groups based on the appropriateness of AC prescribing: inappropriate (iAC) and appropriate (aAC).

Results. The mean age was 90±4 years; patients had an average of 4±1 chronic conditions and were taking 6±3 medications on admission. AC prescribing was iAC in 22 cases (27.5%): 9 no AC, 8 reduced-dose AC, 5 enoxaparin. In univariate analysis, age, mean Hb, and history of bleeding were significantly different between the two groups: Hb (g/dl) iAC 10±3 vs aAC 12±1, p=.004; bleeding (% of cases) iAC 41% vs aAC 16%, p=.015. In multivariate analysis (logistic regression), Hb < 11 g/dl (OR 3.5, 95% CI 1.2–10.8, p = 0.027) and previous bleeding (OR 5.5, 95% CI 1.5–19.3, p=.008) were confirmed as the sole predictors of inappropriate AC prescribing in AF, whilst age was not significant (>94 vs 85–89 years, OR 2.4, 95% CI 0.5–11.0, p=.243)

Conclusions. The preliminary results of the study highlight that variables related to AC safety are the most significant factor in inappropriate AC management.

Introduzione. La terapia anticoagulante (AC) nei pazienti grandi anziani fragili con fibrillazione atriale (FA) rappresenta una sfida per il complesso equilibrio tra rischio tromboembolico ed emorragico.

Materiali e Metodi. In uno studio retrospettivo abbiamo analizzato i pattern prescrittivi AC in 83 pazienti di età ≥ 85 anni ricoverati con FA nella nostra unità operativa. Sono state investigate variabili demografiche, cliniche, laboratoristiche, e scale di valutazione geriatrica (NEWS, IDA, BRADEN, MORSE). I pazienti sono stati suddivisi in 2 gruppi in base all’appropriatezza prescrittiva AC: inappropriata (iAC), appropriata (aAC).

Risultati. L’età media era 90±4 anni, i pazienti presentavano in media 4±1 patologie croniche, ed assumevano 6±3 farmaci all’ingresso. La prescrizione AC era iAC in 22 casi (27,5%): 9 no AC, 8 AC dose ridotta, 5 enoxaparina. All’analisi univariata, età, Hb media, e pregresso sanguinamento erano significativamente differenti tra i 2 gruppi: Hb (gr/dl) iAC 10±3 vs aAC 12±1, p=.004; sanguinamento (% casi) iAC 41% vs aAC 16%, p=.015. In analisi multivariata (regressione logistica) Hb < 11 gr/dl (OR 3,5, 95%CI 1,2-10,8, p=.027) e pregressa emorragia (OR 5,5, 95%CI 1,5-19,3, p=.008) si confermavano unici predittori di inappropriatezza prescrittiva AC in FA, mentre l’età non risultava significativa (>94 vs 85-89 anni, OR 2,4, 95%CI 05-11,0, p=.243)

Conclusioni. I risultati preliminari dello studio evidenziano come variabili correlate alla sicurezza AC siano il fattore più rilevante nella gestione non appropriata AC.