Bleeding risk of oral anticoagulants in the very elderly

Bleeding risk of oral anticoagulants in the very elderly

Bleeding risk of oral anticoagulants in the very elderly: Oral anticoagulants are indicated for prevention of thromboembolism in atrial fibrillation with risk factors as well as for prevention of recurrent venous thromboembolism. Bleeding risk is a substantial concern during this therapy, especially in the elderly. Daniela Poli and colleagues from the Italian Federation of Anticoagulation Clinics evaluated this aspect in a recent study published ahead of print in Circulation [Poli D et al. Bleeding Risk in Very Old Patients on Vitamin K Antagonist Treatment. Results of a Prospective Collaborative Study on Elderly Patients Followed by Italian Centres for Anticoagulation. Circulation. 2011 Aug 16;124(7):824-9]. They recruited about four thousand and one hundred patients aged eighty years and above and accumulated a follow up of over nine thousand six hundred patient years. The ages at the beginning of the study ranged from eighty to one hundred and two years. Major bleeding rate was 1.87 per hundred patient years with a fatality of 0.27 per hundred patient years. The bleeding rate was higher in men and in those aged eighty five years or more. Past history of bleeding, active cancer and history of falls were independent predictors of bleeding risk of oral anticoagulants in a regression analysis. Authors conclude that oral anticoagulants carefully monitored by anticoagulation clinics in very old patients had low bleeding rates and age itself should not be considered as a contraindication. Specifically trained centers for vitamin K antagonist therapy is ideal for these very old and frail patients who benefit from this therapy.