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. 2022 Mar 15;12(3):469.
doi: 10.3390/jpm12030469.

Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Multidisciplinary Consensus Document

Marco Proietti  1   2   3 , Marina Camera  4   5 , Maurizio Gallieni  6   7 , Luigi Gianturco  8 , Antonio Gidaro  7 , Carlo Piemontese  9 , Giuseppe Pizzetti  10 , Franco Redaelli  11 , Barbara Scimeca  12 , Carlo Sebastiano Tadeo  13 , Matteo Cesari  1   2 , Giuseppe Bellelli  14   15 , Laura Adelaide Dalla Vecchia  16
Affiliations

Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Multidisciplinary Consensus Document

Marco Proietti et al. J Pers Med. .

Abstract

In the last twelve years the clinical management of patients with atrial fibrillation has been revolutionised by the introduction of direct oral anticoagulants. Despite the large amount of evidence produced, some populations remain relatively poorly explored regarding the effectiveness and safety of direct oral anticoagulants, such as the oldest and/or frailest individuals. Frailty is clinical syndrome characterized by a reduction of functions and physiological reserves which results in individuals having higher vulnerability. While current evidence underlines a relationship between atrial fibrillation and frailty, particularly in determining a higher risk of adverse outcomes, data regarding effectiveness and safety of direct oral anticoagulants in frailty atrial fibrillation patients are still lacking, leaving uncertainty about how to guide prescription in this specific subgroup. On these premises, this multidisciplinary consensus document explains why it would be useful to integrate the clinical evaluation performed through comprehensive geriatric assessment to gather further elements to guide prescription of direct oral anticoagulants in such a high-risk group of patients.

Keywords: DOAC; atrial fibrillation; bleeding; cardiovascular prevention; frailty; old age; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Lip G.Y.H., Freedman B., De Caterina R., Potpara T.S. Stroke prevention in atrial fibrillation: Past, present and future. Thromb. Haemost. 2017;117:1230–1239. doi: 10.1160/TH16-11-0876. - DOI - PubMed
    1. Proietti M., Lane D.A., Boriani G., Lip G.Y. Stroke Prevention, Evaluation of Bleeding Risk, and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International Guidelines. Can. J. Cardiol. 2019;35:619–633. doi: 10.1016/j.cjca.2019.02.009. - DOI - PubMed
    1. Camm A.J., Accetta G., Ambrosio G., Atar D., Bassand J.-P., Berge E., Cools F., A Fitzmaurice D., Goldhaber S.Z., Goto S., et al. Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. Heart. 2016;103:307–314. doi: 10.1136/heartjnl-2016-309832. - DOI - PMC - PubMed
    1. Huisman M.V., Rothman K.J., Paquette M., Teutsch C., Diener H.-C., Dubner S.J., Halperin J.L., Ma C.S., Zint K., Elsaesser A., et al. The Changing Landscape for Stroke Prevention in AF. J. Am. Coll. Cardiol. 2017;69:777–785. doi: 10.1016/j.jacc.2016.11.061. - DOI - PubMed
    1. Cowan J.C., Wu J., Hall M., Orlowski A., West R.M., Gale C.P. A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation. Eur. Heart J. 2018;39:2975–2983. doi: 10.1093/eurheartj/ehy411. - DOI - PMC - PubMed