Oral anticoagulants in older adults with atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in adults and contributes directly to adverse clinical events, ranging from ischemic stroke to heart failure and cardiovascular death. Because the incidence of AF and its attendant complications increase with age, there is a strong and growing need to develop safe, effective and widely available therapies. The following review summarizes the use of oral anticoagulants in older adults with AF, focusing on practical topics such as drug metabolism, drug-drug interactions, co-morbidities and cost considerations in a complex payer environment.

Figure 1:

eGFR for Americans aged 45–85 years using the modification of diet in renal disease simplified algorithm [74] is presented in the left panel, and estimated creatinine clearance using the Cockcroft and Gault formula [75] is presented in the right panel. For calculations, mean weight and height by decade were obtained from US survey data (NHANES, http://www.cdc.gov), with serum creatinine designated as 1.0 mg/dl. Pink lines and circles represent estimates for women; blue lines and triangles are estimates for men; white, open symbols are estimates for Caucasians; and solid black symbols represent estimates for African Americans. The dotted red line indicates a GFR of 60 ml/min/1.73m2, demarcating the level below which there is at least a moderate decrease in GFR. The brackets enclose GFRs of 30–59 ml/min/m² classified as stage 3 renal disease or moderate GFR decrease (adapted from Schwartz) [17]. Reprinted by permission from Macmillan Publishers Ltd: Clinical Pharmacology and Therapeutics, Schwartz JB (2007).