Anticoagulation Therapy of Atrial Fibrillation in the Elderly

  • G. Di Pasquale
  • E. Cerè
  • A. Lombardi
  • B. Sassone
  • S. Biancoli
  • R. Vandelli
Conference paper


The prevalence of atrial fibrillation (AF) increases substantially with age. The most recent data come from a cross-sectional study of adults in California, dealing with a population of 1.89 million [1]. The overall prevalence of AF was 0.95%; prevalence increased from 0.1% among adults younger than 55 years to 4.0% in subjects older than 60 years and up to 9.0% in persons aged 80 years or older. The authors estimate that approximately 2.3 million adults in the United States currently have AF, and project that this figure will increase to more than 5.6 million by the year 2050, with more than 50% of affected individuals aged 80 years or older. The estimate for AF in Italy is about 500 000 subjects, with an incidence of 60.000 new cases per year.


Atrial Fibrillation Stroke Prevention Atrial Fibrillation Patient Antithrombotic Therapy Mitral Valve Disease 
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  1. 1.
    Go AS, Hylek EM, Phillips KA et al (2001) Prevalence of diagnosed atrial fibrillation in adults. National implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375PubMedCrossRefGoogle Scholar
  2. 2.
    Atrial Fibrillation Investigators (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 154:1449–1457CrossRefGoogle Scholar
  3. 3.
    Hart RG, Pearce LA, McBride R et al, on behalf of the Stroke Prevention in Atrial Fibrillation (SPAF) Investigators (1999) Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation. Analysis of 2012 participants in the SPAF I-III clinical trials. Stroke 30:1223–1229PubMedCrossRefGoogle Scholar
  4. 4.
    Hart RG, Benavente O, McBride R, Pearce LA (1999) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 131:492–501PubMedCrossRefGoogle Scholar
  5. 5.
    Albers GW, Dalen JE, Laupacis A, Manning WJ, Petersen P, Singer DE (2001) Antithrombotic therapy in atrial fibrillation. Sixth ACCP Consensus Conference on Antithrombotic Therapy. Chest 119 [Supp1]:194S–206SPubMedCrossRefGoogle Scholar
  6. 6.
    Fuster V, Ryden L et al (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. Am J Cardiol 38:1231–1265CrossRefGoogle Scholar
  7. 7.
    Di Pasquale G, Cerè E, Biancoli S et al (2002) Antiplatelet agents for prevention of thromboembolism in atrial fibrillation: when, why, and which one? In: Raviele A (ed) Cardiac Arrhythmias 2001. Springer, Milan, pp 422–435Google Scholar
  8. 8.
    Bungard TJ, Ghali WA, Teo KK, Mc Alister FA, Tsuyuki RT (2000) Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 160:41–46PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen N, Sarafian DA, Alon I et al (2000) Warfarin for stroke prevention still underused in atrial fibrillation. Stroke 31:1217–1222PubMedCrossRefGoogle Scholar
  10. 10.
    Petersen P, Boysen G, Godtfredsen J et al (1989) Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK Study. Lancet 1:175–179PubMedCrossRefGoogle Scholar
  11. 11.
    Stroke Prevention in Atrial Fibrillation Investigators (1994) Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 343:687–691Google Scholar
  12. 12.
    Sebastian J, Tresch DD (2000) Use of oral anticoagulants in older patients. Drugs Aging 16:409–435PubMedCrossRefGoogle Scholar
  13. 13.
    Beyth RJ, Landefeld S (1995) Anticoagulants in older patients: a safety perspective. Drugs Aging 6:45–54PubMedCrossRefGoogle Scholar
  14. 14.
    Palareti G, Leali N, Coccheri S et al, on behalf of the Italian Study on Complications of Oral Anticoagulant Therapy (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 348:423–28PubMedCrossRefGoogle Scholar
  15. 15.
    Palareti G, Hirsh J, Legnani C et al (2000) Oral anticoagulation treatment in the elderly: a nested prospective, case-control study. Arch Intern Med 160:470–478PubMedCrossRefGoogle Scholar
  16. 16.
    Pengo V, Legnani C, Noventa F, Palareti G, on behalf of the ISCOAT Study Group (2001) Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding. Thromb Haemost 85:418–422Google Scholar
  17. 17.
    Landefeld CS, Goldman L (1989) Major bleeding in outpatients treated with warfarin. Incidence and prediction by factors known at the start of outpatient therapy. Am J Med 87:144–152PubMedCrossRefGoogle Scholar
  18. 18.
    Wehinger C, Stollberger C, Langer T, Schneider B, Finsterer J (2001) Evaluation of risk factors for stroke/embolism and of complications due to anticoagulant therapy in atrial fibrillation. Stroke 32:2246–2252PubMedCrossRefGoogle Scholar
  19. 19.
    Palareti G, Poggi M, Guazzaloca G et al (1997) Assessment of mental ability in elderly anticoagulated patients: its reduction is associated with a less satisfactory quality of treatment. Blood Coagul Fibrinolysis 8:411–417PubMedCrossRefGoogle Scholar
  20. 20.
    Ansell JE, Hughes R (1996) Evolving models of warfarin management: anticoagulation clinics, patient self-monitoring, and patient self-management. Am Heart J 132:1095–1100PubMedCrossRefGoogle Scholar
  21. 21.
    Chiquette E, Amato MG, Bussey HI (1998) Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 158:1641–1647PubMedCrossRefGoogle Scholar
  22. 22.
    Fitmaurice DA, Hobbs FD, Delaney BC, Wilson S, McManus R (1998) Review of computerized decision support system for oral anticoagulation management. Br J Hematol 102:907–909CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • G. Di Pasquale
    • 1
  • E. Cerè
    • 1
  • A. Lombardi
    • 1
  • B. Sassone
    • 1
  • S. Biancoli
    • 1
  • R. Vandelli
    • 1
  1. 1.Unità Operativa di CardiologiaOspedale di BentivoglioBolognaItaly

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