Cavallari Ilaria, Patti Giuseppe
Department of Cardiovascular Science, Campus Bio-Medico University of Rome; Rome-Italy.
Anatol J Cardiol. 2018 Jan;19(1):67-71. doi: 10.14744/AnatolJCardiol.2017.8256.
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding. Despite the better safety profiles of DOACs compared with warfarin, elderly patients often remain undertreated because of the fear of bleeding complications. This review summarizes current evidence regarding the risks of thromboembolisms and bleeding in different antithrombotic strategies in elderly patients (aged ≥75 years) with atrial fibrillation, including data from the warfarin-controlled phase 3 DOACs trials.
与年轻患者相比，老年房颤患者发生缺血性事件和出血事件的风险更高；因此，在这一人群中平衡抗栓策略的风险和获益至关重要。最近的研究表明，由于卒中风险随年龄增长的幅度超过出血风险，口服抗凝治疗在老年患者中的绝对获益最高，其获益超过出血风险。直接口服抗凝药（DOACs）已被开发用于预防心源性栓塞性卒中，以克服华法林的一些局限性，如需要频繁监测、INR值不稳定需要频繁调整剂量、饮食和药物相互作用以及颅内出血风险增加。尽管与华法林相比，DOACs的安全性更好，但老年患者往往因担心出血并发症而治疗不足。本综述总结了目前关于老年（≥75岁）房颤患者不同抗栓策略中血栓栓塞和出血风险的证据，包括来自华法林对照的3期DOACs试验的数据。
