Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls

Candice L Garwood, PharmD BCPS; Tia L Corbett, PharmD

Disclosures

The Annals of Pharmacotherapy. 2008;42(4):523-532. 

In This Article

Anticoagulation Care and Education in the Elderly

Concerns about bleeding may lead to underutilization of warfarin, particularly in the elderly. The ACCP guidelines promote more frequent INR monitoring in elderly patients.[2] Several retrospective, nonrandomized studies have demonstrated that anticoagulation clinics improve the quality of anticoagulation care by reducing bleeding, improving time within the therapeutic range, and decreasing thromboembolism.[57] A combined retrospective and prospective cohort study of 15,387 patients investigated the relationship between bleeding incidence in the elderly and anticoagulation education.[58] Patients aged 80 years and older were surveyed regarding the quality of anticoagulation education that they had received. Only 21.3% of the patients defined their education on anticoagulation as satisfactory, while more than 17% stated that their education was insufficient. A disappointing 61.1% of the respondents said that they did not receive any education. Patients reporting insufficient anticoagulation education had the highest number of major bleeding events, while those with sufficient education had the lowest number of major bleeding events. Many of the patients in this study had multiple comorbidities, including cognitive impairment. Over half of the study population was over 85 years of age, and many were over age 90. Neither age nor cognitive status was found to be associated with bleeding incidence, and overall bleeding rates were found to be low. However, quality of patient education on anticoagulation therapy appears to be an important variable in reducing the risk of bleeding. The authors concluded that insufficient education may be worse than no education. The American Society of Health-System Pharmacists advocates that pharmacists have an active role in educating and monitoring patients to optimize anticoagulation safety and effectiveness.[59]

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