NDLI: Optimal Stroke Prevention in the Geriatric Patient with Atrial Fibrillation: Position Paper of an Interdisciplinary Expert Panel.

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Optimal Stroke Prevention in the Geriatric Patient with Atrial Fibrillation: Position Paper of an Interdisciplinary Expert Panel.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Bahrmann, P. Wehling, M. Ropers, D. Flohr, J. Leischker, A. Röther, J.
Description	Country affiliation: Germany Author Affiliation: Bahrmann P ( Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany.); Wehling M ( Institute of Experimental and Clinical Pharmacology and Toxicology, Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.); Ropers D ( Department of Internal Medicine 2 (Cardiology), University of Erlangen, Germany.); Flohr J ( General Medicine Practice, Leipzig, Germany.); Leischker A ( Alexianer Krefeld Clinic for General Internal and Geriatric Medicine GmbH, Krefeld, Germany.); Röther J ( Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany.)
Abstract	The present position paper summarises the outcomes of an expert panel discussion held by hospital-based and office-based physicians with ample experience in the treatment of geriatric patients. The optimal approach to stroke prevention in geriatric patients with atrial fibrillation (AF) has not been adequately clarified. Despite their high risk of stroke and clear indication for anticoagulation according to established risk scores, in practice geriatric AF patients often are withheld treatment because of comorbidities and comedications, concerns about low treatment adherence or fear of bleeding events, in particular due to falls. The panel agreed that geriatric patients should receive oral anticoagulation as a rule, unless a comprehensive neurological and geriatric assessment (including clinical examination, gait tests and validated instruments such as Modified Rankin Scale, Mini-mental state examination or Timed Test of Money Counting) provides sound reasons for refraining from treatment. All patients with a history of falls should be thoroughly evaluated for further evaluation of the causes. Patients with CHADS2 score ≥ 2 should receive anticoagulation even if at high risk for falls. The novel oral anticoagulants (NOAC) facilitate management in the geriatric population with AF (no INR monitoring needed, easier bridging during interventions) and have, based on available data, an improved benefit-risk ratio compared to vitamin K antagonists. Drugs with predominantly non-renal elimination are safer in geriatric patients and should be preferred.
File Format	HTM / HTML
ISSN	21949379
Issue Number	10
Volume Number	65
e-ISSN	21949387
Journal	Drug Research
Language	English
Publisher	Thieme
Publisher Date	2015-10-01
Publisher Place	Germany
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Anticoagulants Administration & Dosage Atrial Fibrillation Drug Therapy Stroke Prevention & Control Accidental Falls Age Factors Aged Aged, 80 And Over Adverse Effects Therapeutic Use Complications Hemorrhage Chemically Induced Humans Risk Etiology Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Medicine Drug Discovery

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