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Inicio Medicina Clínica (English Edition) Antithrombotic treatment and characteristics of elderly patients with non-valvul...
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Vol. 148. Issue 5.
Pages 204-210 (March 2017)
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Vol. 148. Issue 5.
Pages 204-210 (March 2017)
Original article
Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry
Características y tratamiento antitrombótico de los pacientes ancianos con fibrilación auricular no valvular hospitalizados en Medicina Interna. Registro NONAVASC
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Alejandra Gullóna,
Corresponding author
a.gullon.ojesto@hotmail.com

Corresponding author.
, Carmen Suáreza, Jesús Díez-Manglanob, Francesc Formigac, José María Cepedad, Antonio Posee, Miguel Camafortf, Jesús Castiellag, Eduardo Rovirah, José María Mostazai, on behalf of the NONAVASC study investigators
a Servicio de Medicina Interna, Hospital Universitario de La Princesa. Madrid, Spain
b Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
c Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
d Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, Spain
e Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
f Servicio de Medicina Interna, Hospital Universitari Clínic Barcelona, Barcelona, Spain
g Servicio de Medicina Interna, Fundación Hospital Calahorra, Calahorra, La Rioja, Spain
h Servicio de Medicina Interna, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
i Servicio de Medicina Interna, Hospital Carlos III, Madrid, Spain
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Figures (2)
Tables (3)
Table 1. NONAVASC's registry sample characteristics.
Table 2. Clinical characteristics of patients according to antithrombotic strategy.
Table 3. Multivariate analysis of clinical and functional factors related to various antithrombotic strategies. Significant variables in the logistic regression model.
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Abstract
Background and objectives

The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies.

Patients and methods

Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments.

Results

We evaluated 804 patients with a mean age of 85 years (range 75–101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favored the use of anticoagulants.

Conclusions

Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice.

Keywords:
Non-valvular atrial fibrillation
Elderly
Antithrombotic treatment
Resumen
Introducción y objetivos

La prevalencia de fibrilación auricular no valvular (FANV) aumenta con la edad y se asocia a alta morbimortalidad. El objetivo principal fue conocer las características de los pacientes ancianos con FANV hospitalizados y los factores clínico-funcionales que determinan la estrategia antitrombótica utilizada.

Pacientes y métodos

Estudio observacional, prospectivo, multicéntrico realizado en pacientes mayores de 75 años con FANV, hospitalizados por cualquier causa en Medicina Interna.

Resultados

Se evaluaron 804 pacientes con una edad media de 85 años (rango: 75–101); el 53,9% fueron mujeres. La prevalencia de factores de riesgo y enfermedades vasculares fue elevada: hipertensión (87,6%), insuficiencia cardíaca (65,4%), cardiopatía isquémica (24,4%), enfermedad cerebrovascular (22,4%) e insuficiencia renal (45%). Entre los pacientes con diagnóstico previo al ingreso de FANV el 86,2% recibía tratamiento antitrombótico: anticoagulantes (59,7%), antiagregantes (AAG) (17,8%) y doble terapia (8,7%). Los factores asociados con la utilización del mismo fueron el antecedente de síndrome coronario agudo y la FANV de más de un año de evolución. Se asociaron con el uso de antiagregación la edad avanzada, la FANV de menos de un año de evolución, las puntuaciones superiores de HAS-BLED y el deterioro cognitivo grave. La fibrilación auricular permanente favorecía la prescripción de anticoagulantes.

Conclusiones

Los pacientes mayores de 75 años con FANV hospitalizados en Medicina Interna tienen numerosas comorbilidades. El porcentaje de anticoagulación es escaso y un 18% recibe solo antiagregación, influyendo en su selección la edad, el tiempo de evolución de la fibrilación auricular y la gravedad del deterioro cognitivo.

Palabras clave:
Fibrilación auricular no valvular
Ancianos
Tratamiento antitrombótico

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