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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 December;22(4):370-5


language: English

Oral anticoagulation in older patients with vascular or cardiovascular diseases. Aged over 70 years: same risk? Same benefit?

Hirschl M., Pluschnig U., Kundi M., Katzenschlager R.

Department of Angiology, Hanuschkrankenhaus, Vienna, Austria


Aim. The pur­pose of the study was to ­assess ­patients aged over 70 years and young­er ­patients for pos­sible dif­fer­enc­es in sev­er­al ­aspects con­cern­ing anti­co­ag­u­lant ther­a­py.
Methods. Two-hun­dred and twen­ty-three ­patients with anti­co­ag­u­lant treat­ment for an aver­age dura­tion of 2.6 years at an angio­log­ic out­pa­tient clin­ic were sub­di­vid­ed into 2 ­groups (above 70 years n=114; below 70 years n=109). The 2 ­groups were com­pared with ­regard to ­patient-spe­cif­ic data, treat­ment-relat­ed and com­pli­ance param­e­ters as well as com­pli­ca­tions.
­Results. The group of older ­patients includ­ed a high­er num­ber of ­female ­patients, pre­sent­ed with a less favor­able risk pro­file and ­revealed ten­den­cy or sig­nif­i­cance in show­ing bet­ter com­pli­ance data. No dif­fer­enc­es were found for the inci­dence of bleed­ing com­pli­ca­tions, while recur­renc­es were more fre­quent in ­patients below the age of 70 years. Treat­ment-relat­ed param­e­ters reflect­ing qual­ity and stabil­ity of anti­co­ag­u­lant ther­a­py (stan­dard devi­a­tion of inter­na­tion­al ratio (INR), fre­quen­cy of labor­a­to­ry con­trols) rep­re­sent pre­dic­tors of bleed­ing risk being of more crit­i­cal impor­tance than the age of the ­patient. Recur­rent ­events also ­showed cor­re­la­tion with same rel­e­vant param­e­ters. Young­er ­patients under­go­ing the same inten­sity of treat­ment for sim­i­lar­ly dis­trib­ut­ed indi­ca­tions show a high­er rate of recur­renc­es.
Con­clu­sion. The lower recur­rence rate in older ­patients is con­sis­tent with the obser­va­tion that anti­co­ag­u­lant ther­a­py is more prof­it­able in eld­er­ly with atri­al fib­ril­la­tion. Since older ­patients being treat­ed with the same ther­a­py inten­sity for com­par­able peri­ods of time ­showed no high­er bleed­ing risk than that seen for young­er ­patients, we ­believe that there is no need for spe­cif­ic guide­lines for older ­patients pro­vid­ed treat­ment is care­ful­ly mon­i­tored and con­trolled.

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