Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients.
Review published in American heart journal (2011)
Abstract
Atrial fibrillation (AF) affects 2.5 million patients in the United States. The incidence of this condition increases with age, such that approximately 5% of people > 65 years of age have AF. Because of the lack of organized atrial contraction and thrombus formation in the left atrium, patients with AF are at increased risk of stroke. The estimated risk of stroke among all AF patients is 5% per year. Among patients without mitral stenosis, there is a graded relationship of stroke risk with the number of CHADS₂ risk factors. Warfarin is the recommended treatment for embolic stroke prophylaxis in AF in intermediate- to high-risk patients. However, elderly patients who are deemed to be at risk of falls are often not started on warfarin therapy secondary to a perceived higher risk of bleeding complications. These risks have been evaluated, but conclusive data regarding the risk-benefit trade-off are elusive. This review summarizes available data on the use of warfarin in elderly patients with AF, focusing on the risk of bleeding, and will specifically address the utility of falls risk assessment in the decision to initiate warfarin therapy for AF.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Atrial fibrillation (AF) affects 2.5 million patients in the United States. The incidence of this condition increases with age, such that approximately 5% of people > 65 years of age have AF. Because of the lack of organized atrial contraction and thrombus formation in the left atrium, patients with AF are at increased risk of stroke.
Why This Matters for Hirudotherapy
This narrative review summarizes the use of warfarin for stroke prophylaxis in elderly atrial-fibrillation patients, noting that AF raises stroke risk in a graded relationship with CHADS2 risk factors and that older patients judged to be at fall risk are frequently denied warfarin out of bleeding concern, while acknowledging that conclusive risk-benefit data on the falls question remain elusive. For ASH it illustrates the central clinical dilemma of anticoagulation — balancing thrombosis prevention against bleeding risk in vulnerable patients — which is the same therapeutic tension that frames interest in leech-derived antithrombotics, where understanding the bleeding/clotting trade-off is essential to any drug-discovery story built on the medicinal-leech secretome. Honest caveat: this is a 2011 review of warfarin-era evidence with no randomized data of its own, predates routine direct-oral-anticoagulant use, and has no connection to leech therapy; ASH cites it purely as background on anticoagulation decision-making.
Citation
Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients.
Sellers MB et al. · American heart journal, 2011
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