Proietti Marco, Camera Marina, Gallieni Maurizio, Gianturco Luigi, Gidaro Antonio, Piemontese Carlo, Pizzetti Giuseppe, Redaelli Franco, Scimeca Barbara, Tadeo Carlo Sebastiano, Cesari Matteo, Bellelli Giuseppe, Dalla Vecchia Laura Adelaide
Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
J Pers Med. 2022 Mar 15;12(3):469. doi: 10.3390/jpm12030469.
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.
在过去的十二年里，直接口服抗凝剂的引入彻底改变了心房颤动患者的临床管理。尽管已有大量证据，但在直接口服抗凝剂的有效性和安全性方面，仍有一些人群研究相对较少，比如年龄最大和/或最虚弱的个体。衰弱是一种临床综合征，其特征是功能和生理储备减少，导致个体更易患病。虽然目前的证据强调了心房颤动与衰弱之间的关系，特别是在确定更高的不良结局风险方面，但关于直接口服抗凝剂在衰弱性心房颤动患者中的有效性和安全性的数据仍然缺乏，这使得在这个特定亚组中如何指导用药存在不确定性。基于这些前提，这份多学科共识文件解释了为何通过综合老年评估进行临床评估以收集更多要素来指导此类高危患者直接口服抗凝剂的处方是有用的。
