Debray M, Pautas E, Couturier P, Franco A, Siguret V
Département de médecine gériatrique et communautaire, centre hospitalier universitaire, 38043 cedex 09, Grenoble, France.
Rev Med Interne. 2003 Feb;24(2):107-17. doi: 10.1016/s0248-8663(02)00020-6.
Atrial fibrillation and venous thromboembolism are particularly frequent in the elderly. Whether or not prescribe oral anticoagulant treatment in the elderly is therefore a common question for the physician. Despite the benefits of anticoagulation demonstrated in clinical trials, oral anticoagulant therapy is underused in the elderly.
Indications for oral anticoagulation are discussed specifically in the elderly with a literature review. Only the length of anticoagulation treatment after a venous thromboembolism remained a purpose of discussion regarding the severity of the pathology. The frequency of systemic thromboembolism in nonvalvular atrial fibrillation is increasing with age. Oral anticoagulation reduces this risk. This benefice is to compare with the increasing rate of major bleeding complications in the elderly and in patient who had stroke, hyper-tension, diabetes mellitus or gastrointestinal bleeding. The objective of this article is to focus on the mode to measure oral anticoagulant benefice/risk ratio in the elderly and to propose several ways to minimize the risk for bleeding.
The potential drug side effect severity of oral anticoagulation must lead to find the "reasonable" clinical indications in term of benefice/risk ratio and what measures should be take to increase the safety of oral anticoagulation in the elderly. The comprehensive geriatric evaluation should be considered as a decision-aid tool in long-term oral anticoagulation in the frail elderly. Anticoagulation clinics, informatics'-prescription coupled with dose-adaptation decision-aid adapted to the elderly should be helpful in this research of quality. Finally, prescribers education supports must insist on the early course of therapy that is at higher risk of bleeding.
心房颤动和静脉血栓栓塞在老年人中尤为常见。因此，是否对老年人开具口服抗凝治疗药物是医生常面临的问题。尽管临床试验已证明抗凝治疗有益，但口服抗凝治疗在老年人中未得到充分应用。
通过文献综述专门讨论老年人口服抗凝治疗的适应证。静脉血栓栓塞后抗凝治疗的时长仍是关于病情严重程度讨论的一个方面。非瓣膜性心房颤动中系统性血栓栓塞的发生率随年龄增长而增加。口服抗凝治疗可降低这种风险。需将这一益处与老年人以及患有中风、高血压、糖尿病或胃肠道出血的患者中主要出血并发症发生率的增加相比较。本文的目的是关注衡量老年人口服抗凝治疗效益/风险比的方式，并提出几种将出血风险降至最低的方法。
口服抗凝治疗潜在的药物副作用严重性必然促使我们在效益/风险比方面找到“合理”的临床适应证，以及应采取哪些措施来提高老年人口服抗凝治疗的安全性。综合老年评估应被视为体弱老年人长期口服抗凝治疗的决策辅助工具。抗凝门诊、信息学处方以及结合适合老年人的剂量调整决策辅助工具，应有助于这项质量研究。最后，处方者教育支持必须强调治疗早期出血风险较高。
