Department of Geriatrics, Medical University of Bialystok, Fabryczna Str. 27, 15-471, Bialystok, Poland.
Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland.
J Thromb Thrombolysis. 2020 Jan;49(1):18-26. doi: 10.1007/s11239-019-01937-3.
Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), but they are often underused in this particularly high-risk population. The aim of the study was to identify health and functional determinants of oral anticoagulant therapy (OA) in AF at discharge from a geriatric sub-acute ward. A cross-sectional study was conducted and patients who presented with atrial fibrillation were analyzed. They were interviewed, examined, assessed with comprehensive geriatric assessment protocol, and had their hospital records analyzed. Relative risks for OA were counted and multivariable logistic regression model was built. 95 patients took part in the study (22.8% of 416 consecutively admitted to the department, 31.9% men, 73.7% 80 + year-old). 25.8% of them were on antiplatelet drugs and 58.9% on OACs. The percentage on OACs increased significantly to 73.7% at discharge (p = 0.004), mainly due to the new OACs prescription (from 11.8 to 33.3%; p < 0.001). Severe frailty (7 point Clinical Frailty Scale ≥ 6) and anemia presence, but not the risk of bleeding according to the HAS-BLED score, significantly decreased the probability of OACs prescription at discharge. There was also a trend for an association of OACs prescription with the higher total score of CHA2DS2-VASc scale. We conclude that in the real-life population of patients with AF comprehensive geriatric assessment might allow to increase significantly the number of patients on OACs, but it is limited by patient's frailty status and anemia diagnosis.
口服抗凝剂 (OAC) 可有效预防老年房颤 (AF) 患者的中风，但在这一高危人群中，OAC 的使用往往不足。本研究旨在确定老年亚急性病房出院时 AF 患者口服抗凝治疗 (OA) 的健康和功能决定因素。进行了一项横断面研究，分析了出现房颤的患者。对他们进行了访谈、检查、使用全面老年评估方案进行评估，并分析了他们的住院记录。计算了 OA 的相对风险，并建立了多变量逻辑回归模型。95 名患者参加了这项研究（416 名连续入院患者的 22.8%，31.9%为男性，73.7%为 80 岁以上）。其中 25.8%服用抗血小板药物，58.9%服用 OAC。OAC 的比例在出院时显著增加至 73.7%（p=0.004），主要是由于新的 OAC 处方（从 11.8%增加至 33.3%；p<0.001）。严重虚弱（临床虚弱量表 7 分≥6 分）和贫血的存在，但不是根据 HAS-BLED 评分的出血风险，显著降低了出院时开具 OAC 的可能性。OA 处方与 CHA2DS2-VASc 评分的总得分较高也存在关联趋势。我们得出结论，在 AF 患者的实际人群中，全面老年评估可能会显著增加接受 OAC 治疗的患者数量，但受到患者虚弱状态和贫血诊断的限制。
