Skip to main content

Table 3 Main recommendations performed in elderly patients with AF

From: Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach

Except when the risk of bleeding is very high, anticoagulation is required to prevent the risk of stroke in elderly patients with AF.
Antiplatelet agents should only be considered in those patients who reject taking anticoagulants and have concomitant vascular disease.
It is essential to identify those factors that increase the risk of hemorrhage (i.e. high blood pressure, concomitant use of non-steroidal anti-inflammatory drugs, alcohol abuse, etc.) in order to modify them to reduce this risk.
To reduce the risk of gastrointestinal bleeding in patients taking anticoagulants, VKA should be carefully controlled over time. In case of treatment with DOACs, dosage should be carefully prescribed according to age (dabigatran and apixaban) weight (dabigatran, rivaroxaban and apixaban) and creatinine clearance (dabigatran, rivaroxaban and apixaban). The use of non-steroidal anti-inflammatory drugs or antiplatelet agents as well as alcohol abuse should be avoided.
In patients with platelet count >100,000/dL, anticoagulation can be normally prescribed. If platelet count is between 50,000 and 100,000/dL, risk/benefit ratio should be carefully individualized.
Anemia by itself should not be considered as an absolute contraindication for initiating anticoagulation, but a strict control and follow-up should be performed.
DOACs can be safely used in patients with moderate renal dysfunction, but dose adjustment is required. VKA can be used regardless renal function.
Dementia by itself should not be considered as an absolute contraindication for anticoagulation. Factors such as the severity of dementia, quality of life, life expectancy, and the presence of other comorbidities should also be considered. These factors should be periodically reevaluated.
In patients at risk of frequent falls with a CHADS2 score ≥3, the beneficial effect of anticoagulation is higher than the risk of intracranial hemorrhage. By contrast, in those patients with a CHADS2 score <2 and frequent falls, anticoagulation should be avoided. In this context, it is reasonable to recommend the use of DOACs over VKA.
Reducing blood pressure to recommended targets (<160/90 mmHg, preferably <140/90 mmHg when tolerated) is mandatory in elderly patients with AF.
It is not recommended to perform a cranial computed tomography or magnetic resonance in all elderly patients who require anticoagulation.
Frailty by itself should not contraindicate the use of anticoagulants, but particular caution should be taken in this population
  1. VKA vitamin K antagonists, DOACs new direct oral anticoagulants