Stroke Risk Should Be Considered in Elderly Candidates for Antithrombotic Therapy

NEW YORK (Reuters Health) Mar 15 – Physicians need to weigh the risk of stroke and gastrointestinal bleeding before starting elderly patients with atrial fibrillation (AF) on anticoagulant therapy with warfarin or aspirin, Canadian researchers report.
In an interview with Reuters Health, lead researcher, Dr. Malcolm Man-Son-Hing from Ottawa Hospital said that "physicians tend to over estimate the risk of gastrointestinal bleeding and underestimate the risk of stroke in older AF patients."

Writing in the March 11th issue of the Archives of Internal Medicine, Dr. Man-Son-Hing and colleagues report on the results of a Markov decision model they used to determine the preferred treatment for AF patients 65 years of age and older who had no other contraindications to anticoagulant therapy. They obtained their input data from a review of MEDLINE.

Their model showed that for patients 65 years of age, who had an average stroke risk of 6.0% per year and an average upper gastrointestinal bleeding risk of 1.17% per year, warfarin therapy was associated with 12.1 quality-adjusted life-years (QALYs) per patient and aspirin therapy was associated with 10.8 QALYs. Individuals who receive no anticoagulant therapy had 10.1 QALYs.

Among patients 75 years of age with a risk of stroke of < 6.0% % per year, who were also taking nonsteroidal antiinflammatory drugs, warfarin was no longer the optimal choice of therapy. For these patients with a significantly increased risk of upper gastrointestinal bleeding, warfarin was associated with 7.44 QALYs, aspirin with 7.51 QALYs and no anticoagulant therapy with 7.42 QALYs, Dr. Man-Son-Hing's group found.

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