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Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches

Verma, LA, Penson, PE, Akpan, A, Lip, GYH and Lane, DA (2023) Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches. Expert Review of Cardiovascular Therapy, 21 (12). pp. 963-983. ISSN 1477-9072

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INTRODUCTION: Oral anticoagulants (OACs) are the cornerstone of stroke prevention in atrial fibrillation (AF), but prescribing decisions in older people are complicated. Clinicians must assess the net clinical benefit of OAC in the context of multiple chronic conditions, polypharmacy, frailty and life expectancy. The under-representation of high-risk, older adult sub-populations in clinical trials presents the challenge of choosing the right OAC, where a 'one-size-fits-all' approach cannot be taken. AREAS COVERED: This review discusses OAC approaches for stroke prevention in older people with AF and presents a prescribing aid to support clinicians' decision-making. High-risk older adults with multiple chronic conditions, specifically chronic kidney disease, dementia/cognitive impairment, previous stroke/transient ischemic attack or intracranial hemorrhage, polypharmacy, frailty, low body weight, high falls risk, and those aged ≥75 years are considered. EXPERT OPINION: Non-vitamin K antagonist OACs are the preferred first-line OAC in older adults with AF, including high-risk subpopulations, after individual assessment of stroke and bleeding risk, except those with mechanical heart valves and moderate-to-severe mitral stenosis. Head-to-head comparisons of NOACs are not available, therefore the choice of drug (and dose) should be based on an individual's risk (stroke and bleeding) and incorporate their treatment preferences. Treatment decisions must be person-centered and principles of shared decision-making applied.

Item Type: Article
Uncontrolled Keywords: Anticoagulants; atrial fibrillation; frailty; multimorbidity; non-vitamin K antagonist oral anticoagulants; older people; stroke; vitamin K antagonists; 1102 Cardiorespiratory Medicine and Haematology; 1117 Public Health and Health Services; Cardiovascular System & Hematology
Subjects: R Medicine > RS Pharmacy and materia medica
R Medicine > RT Nursing
Divisions: Nursing & Allied Health
Pharmacy & Biomolecular Sciences
Publisher: Taylor and Francis
SWORD Depositor: A Symplectic
Date Deposited: 21 Dec 2023 11:39
Last Modified: 21 Dec 2023 11:45
DOI or ID number: 10.1080/14779072.2023.2276892
URI: https://researchonline.ljmu.ac.uk/id/eprint/22141
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