Warfarin in vulnerable older adults with atrial fibrillation. [Review]

Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC 27715, USA.
Journal of Thrombosis and Thrombolysis (Impact Factor: 2.17). 06/2009; 27(4):461-4. DOI: 10.1007/s11239-009-0344-0
Source: PubMed
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    ABSTRACT: This study's aims were to evaluate patient knowledge of safe warfarin practices early in treatment, and to pilot a nursing telephone follow-up enhancement to a pharmacy-facilitated discharge. Forty-two randomized patients in either "enhanced follow-up" or "treatment as usual" groups completed the study. Enhanced treatment resulted in significant improvement in warfarin knowledge (86% versus 71%). In critical safety related knowledge questions even larger improvements were present (∼96% compared to ∼77%). The hypothesis that non-adherence generating rehospitalization is a function of poorer knowledge was not supported as there were no warfarin-related readmissions during the study. The study supports the use of enhanced follow up and the need for larger studies to delineate what patient knowledge prevents rehospitalization and cost effective educational efforts.
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    ABSTRACT: Anticoagulation therapy for thromboembolism prophylaxis in patients with atrial fibrillation (AF) is based on quality information derived from numerous randomized controlled trials but continues to be a conundrum for many physicians. Age is the most cited argument to withhold anticoagulation. Ironically, because of their higher risk of stroke, the net benefit of antithrombotic therapy may be greater in octogenarians than in younger patients. Indeed, given the risk of major bleeding there is reason to be skeptical about net benefit when warfarin is used in some elderly patients with AF. This summary reviews the risks of cardioembolic stroke and bleeding in patients with atrial fibrillation with and without oral anticoagulation and spotlights the problematic nature of anticoagulation underuse in the elderly.
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