Prescription of oral anticoagulation in geriatric patients with atrial fibrillation

Génesis Ramírez-Prieto, Departamento de Geriatría, Hospital General de Zona N.º 67, Instituto Mexicano del Seguro Social, N.L., México
José E. Pombo-Bartelt, Departamento de Cardiología, Instituto Corazón de Querétaro y Hospital Ángeles de Querétaro, Qro., México
Guadalupe Rojas-Calderón, Departamento de Geriatría, Hospital General Regional N.º 1, Instituto Mexicano del Seguro Social, Qro. México
José J. García-González, Departamento de Geriatría, Hospital General Regional N.º 1, Instituto Mexicano del Seguro Social, Qro. México

Objective: To determine the prevalence of prescription of oral anticoagulation in patients aged > 60 years with nonvalvular atrial fibrillation (NVAF). Methods: Observational, cross-sectional, retrospective study based on a review of the clinical histories of patients aged >60 years diagnosed with NVAF from July 1 to September 30, 2019 and seen at the outpatient clinic (cardiology, internal medicine, geriatrics) of a secondary-level hospital in Queretaro, Mexico. Clinical profile and oral anticoagulant treatment were analyzed. Results: The study population comprised 300 patients (mean age, 77.2±8.3 years; 53.3% women; 81% attended in cardiology). Of these, 91% had a high thromboembolic risk, 22.7% a high bleeding risk, and 1.7% contraindications for anticoagulation. Comorbidity was frequent. As for therapy, 82.7% were taking direct oral anticoagulants (DOAC), 11.0% vitamin K antagonists (VKA), and 6.3% no anticoagulant treatment. Anticoagulant therapy was inappropriate in 29.3% of patients, mainly because DOAC were prescribed without adjusting for age, weight, or serum creatinine and administered without indication according to thromboembolic risk. Only 39.4% of patients taking VKA were within the therapeutic range. Of all patients receiving DOAC, 48.0% were taking rivaroxaban, mainly at 20 mg/d (73.1%). Conclusions: Thromboembolic risk is high in geriatric patients with NVAF. Anticoagulation is contraindicated in <2% of patients. Oral anticoagulants are prescribed inappropriately in three out of ten patients.

Keywords: Geriatric. Vitamin K antagonists. Anticoagulation. Direct oral anticoagulants. Atrial fibrillation.