Conundrums for Atrial Fibrillation Management in Older Adults
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- 作者：Alexander C. Fanaroff ; Tracy Y. Wang
- 关键词：Atrial fibrillation ; Aging ; Anticoagulants ; Cardiovascular disease ; Arrhythmias ; cardiac ; Warfarin ; Stroke ; Intracranial embolism and thrombosis ; Frail older adult ; Shared decision making
- 刊名：Current Translational Geriatrics and Experimental Gerontology Reports
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：4
- 期：4
- 页码：368-376
- 全文大小：344 KB
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20.Man-Son-H - 作者单位：Alexander C. Fanaroff (1)
Tracy Y. Wang (2)
1. Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
2. Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, 27705, USA - 刊物主题：Geriatrics/Gerontology; Medicine/Public Health, general; Psychopharmacology; Pain Medicine; Neurology; Rheumatology;
- 出版者：Springer US
- ISSN：2162-4941
文摘
Atrial fibrillation (AF) afflicts over 33 million people worldwide, the large majority of them older than 65, and increases embolic stroke risk fourfold to fivefold. This stroke risk can be reduced by two thirds or more with anticoagulation, although this benefit is balanced by an increased risk of bleeding. Guidelines recommend use of the CHA2DS2-VASc risk score to estimate annual stroke risk and inform shared decision making between patients and providers. Although the net clinical benefit of anticoagulation for stroke prophylaxis in AF is well established in patients with CHA2DS2-VASc scores ?, anticoagulation remains underutilized, especially in older patients. While older patients are at higher risk for bleeding on anticoagulation, they also derive the most benefit from anticoagulation due to their higher stroke risk. In this review, benefits of warfarin and targeted oral anticoagulants will be discussed, and relative utility of these therapies for stroke prophylaxis will be clarified. Keywords Atrial fibrillation Aging Anticoagulants Cardiovascular disease Arrhythmias, cardiac Warfarin Stroke Intracranial embolism and thrombosis Frail older adult Shared decision making