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The Utilization of Antithrombotic Therapy in Older Patients in Aged Care Facilities With Atrial Fibrillation

Frain, B, Castelino, RL and Bereznicki, LR ORCID: 0000-0003-3974-3437 2017 , 'The Utilization of Antithrombotic Therapy in Older Patients in Aged Care Facilities With Atrial Fibrillation' , Clinical and Applied Thrombosis - Hemostasis , pp. 1-6 , doi: 10.1177/1076029616686421.

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Abstract

Oral anticoagulants are essential drugs for the prevention of thromboembolic events in patients with atrial fibrillation (AF).Anticoagulants are, however, commonly withheld in older people due to the risk and fear of hemorrhage. Although theunderutilization of anticoagulants in patients with AF has been demonstrated internationally, few studies have been conductedamong aged care residents. The aim of this study was to determine the utilization of anticoagulants among people with AF residingin aged care facilities. We performed a non-experimental, retrospective analysis designed to evaluate antithrombotic usage inpatients with AF in Australia residing in aged care facilities, using data collected by pharmacists while performing ResidentialMedication Management Reviews (RMMRs). The utilization of antithrombotic therapy and the appropriateness of therapy weredetermined based on the CHADS2, CHA2DS2-VASc, and HAS-BLED risk stratification schemes in consideration of documentedcontraindications to treatment. Predictors of anticoagulant use were determined using multivariate logistic regression. A total of1952 RMMR patients with AF were identified. Only 35.6% of eligible patients (CHADS2 score &ge2 and no contraindications toanticoagulants) received an anticoagulant. As age increased, the likelihood of receiving an anticoagulant decreased and the likelihoodof receiving an antiplatelet or no therapy increased. In patients at high risk of stroke (CHADS score &ge2), utilization ofanticoagulants dropped by 19.7% when the HAS-BLED score increased from 2 to 3, suggesting that physicians placed a heavierweighting on bleeding risk rather than stroke risk. Prescribing of anticoagulants was influenced to a greater extent by bleeding riskthan it was by the risk of stroke. Further research investigating whether the growing availability of direct oral anticoagulantsinfluences practice in this patient population is needed.

Item Type: Article
Authors/Creators:Frain, B and Castelino, RL and Bereznicki, LR
Keywords: anticoagulants, bleeding, blood coagulation factors, factor Xa inhibitors, stroke, thrombosis prophylaxis
Journal or Publication Title: Clinical and Applied Thrombosis - Hemostasis
Publisher: Westminster Publ Inc
ISSN: 1076-0296
DOI / ID Number: 10.1177/1076029616686421
Copyright Information:

Copyright 2017 The Authors

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