Elderly Patient Management Problems: Antithrombotic Therapy Selection Features. Clinical Case
https://doi.org/10.20996/1819-6446-2018-14-4-515-523
Abstract
The growing population of elderly people is the main «antithrombotic drugs consumer» because there is higher prevalence of thromboembolic diseases (acute coronary syndrome, venous thromboembolism, atrial fibrillation) among them than among younger people. Elderly people have high risks of both thromboembolic and bleeding complications associated with antithrombotic drugs using. Antithrombotic drug choice is based on individual careful estimation of the «risk/benefit» ratio. Sometimes real clinical practice gives us problems and questions, having no answers in any guidelines. Such a difficult clinical case of elderly patient management is presented in this article.
About the Authors
D. U. Akasheva
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Dariga U. Akasheva – MD, PhD, Leading Researcher, Department of Fundamental and Applied Aspects of Obesity
Petroverigsky per. 10, Moscow, 101990
E. S. Bulgakova
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Elena S. Bulgakova – MD, Junior Researcher, Department of Fundamental and Applied Aspects of Obesity
Petroverigsky per. 10, Moscow, 101990
I. S. Yavelov
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Igor S. Yavelov – MD, PhD, Leading Researcher, Department of Clinical Cardiology and Molecular Genetics
Petroverigsky per. 10, Moscow, 101990
A. Yu. Gorshkov
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Alexander Yu. Gorshkov – MD, PhD, Head of the 3rd Cardiology Department
Petroverigsky per. 10, Moscow, 101990
O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director
Petroverigsky per. 10, Moscow, 101990
References
1. Bourgeois F.T., Orenstein L., Ballakur S. et al. Exclusion of elderly people from randomized clinical trials of drugs for ischemic heart disease. J Am Geriatr Soc. 2017;65(11):2354-61. doi: 10.1111/jgs.14833.
2. Andreotti F., Rocca B., Husted S. et al. Antithrombotic therapy in elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2015;36(46):3238-49. doi: 10.1093/eurheartj/ehv304.
3. Tkacheva O.N., Runikhina N.K., Vorobyeva N.M., et al. Antithrombotic therapy in elderly and senile age: an expert consensus. Cardiovascular Therapy and Prevention. 2017;16(3):4-33. (In Russ.).
4. Ruff C.T., Giugliano R.P., Braunwald E., et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomized trials. Lancet. 2014; 383(9921):955-62. doi: 10.1016/S0140-6736(13)62343-0.
5. Wehling M., Collins R., Gil V.M., Hanon O. Appropriateness of oral anticoagulants for the long-therm treatment of atrial fibrillation in older people: results of an evidence-based review and international consensus validation process (OAC-FORTA 2016). Drugs & Aging. 2017;34(7):499-507. doi: 10.1007/s40266-017-0466-6.
6. Wehling M., Burkhardt H., Kuhn-Thiel A., et al. VALFORTA: a randomized trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing. 2016;45(2):262-7. doi: 10.1093/ageing/afv200.
7. Dewilde W., Oirbans T., Verheugt F. et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381(9872):1107-15. doi: 10.1016/S01406736(12)62177-1.
8. Gibson M.C., Mehran R., Bode C., et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016; 375:2423-34. doi: 10.1056/NEJMoa1611594.
9. Cannon C.P., Bhatt D.L., Oldgren J., et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377(16):1513-24. doi: 10.1056/NEJMoa1708454.
10. Valgimigli M., Bueno H., Byrne R.A., et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213-60. doi: 10.1093/eurheartj/ehx419.
11. Tegn N., Abdelnoor M., Endresen K. et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet. 2016;387(10023):1057-65. doi: 10.1016/S0140-6736(15)01166-6.
Review
For citations:
Akasheva D.U., Bulgakova E.S., Yavelov I.S., Gorshkov A.Yu., Drapkina O.M. Elderly Patient Management Problems: Antithrombotic Therapy Selection Features. Clinical Case. Rational Pharmacotherapy in Cardiology. 2018;14(4):515-523. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-4-515-523
Views: 676
Email this article 