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Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation.

Publication ,  Journal Article
Steinberg, BA; Greiner, MA; Hammill, BG; Curtis, LH; Benjamin, EJ; Heckbert, SR; Piccini, JP
Published in: Cardiovasc Ther
August 2015

AIMS: Oral anticoagulation therapy prevents stroke and improves survival in patients with atrial fibrillation, but the therapy is underutilized. We sought to identify the prevalence of contraindications for oral anticoagulation and the proportion of patients potentially eligible for different agents. METHODS: We identified patients with nonacute atrial fibrillation in a nationally representative 5% sample of 2009 Medicare data. We divided the population into patients ineligible for any oral anticoagulant, patients eligible for warfarin only, and patients eligible for any anticoagulant. We compared patient characteristics and the use of anticoagulation among the subgroups. RESULTS: Among 86,671 patients with atrial fibrillation, 1872 (2.2%) were ineligible for anticoagulation because of an absolute contraindication, most frequently a history of intracranial hemorrhage (60%). Patients ineligible for any anticoagulant were the same age as the overall group (mean age, 80.5 vs. 80.4 years). However, they had higher rates of dementia (19% vs. 8.6%) and heart failure (59% vs. 43%) and higher mean CHADS2 scores (3.8 vs. 2.8). Of the remaining 84,799 patients eligible for anticoagulation, 7146 (8.4%) were eligible for warfarin only (most commonly because of mechanical heart valves [66%] and end-stage renal disease [12%]). Sixty-five percent of patients eligible for anticoagulation received warfarin, and the proportion was similar for patients with a relatively high risk of bleeding. CONCLUSIONS: Older adults with atrial fibrillation rarely have absolute contraindications to oral anticoagulation therapy. Among patients without contraindications, most appeared to be eligible for any anticoagulant, and relatively high-risk features appeared not to influence warfarin use.

Duke Scholars

Published In

Cardiovasc Ther

DOI

EISSN

1755-5922

Publication Date

August 2015

Volume

33

Issue

4

Start / End Page

177 / 183

Location

England

Related Subject Headings

  • Warfarin
  • United States
  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Patient Selection
  • Medicare
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
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Steinberg, B. A., Greiner, M. A., Hammill, B. G., Curtis, L. H., Benjamin, E. J., Heckbert, S. R., & Piccini, J. P. (2015). Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation. Cardiovasc Ther, 33(4), 177–183. https://doi.org/10.1111/1755-5922.12129
Steinberg, Benjamin A., Melissa A. Greiner, Bradley G. Hammill, Lesley H. Curtis, Emelia J. Benjamin, Susan R. Heckbert, and Jonathan P. Piccini. “Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation.Cardiovasc Ther 33, no. 4 (August 2015): 177–83. https://doi.org/10.1111/1755-5922.12129.
Steinberg BA, Greiner MA, Hammill BG, Curtis LH, Benjamin EJ, Heckbert SR, et al. Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation. Cardiovasc Ther. 2015 Aug;33(4):177–83.
Steinberg, Benjamin A., et al. “Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation.Cardiovasc Ther, vol. 33, no. 4, Aug. 2015, pp. 177–83. Pubmed, doi:10.1111/1755-5922.12129.
Steinberg BA, Greiner MA, Hammill BG, Curtis LH, Benjamin EJ, Heckbert SR, Piccini JP. Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation. Cardiovasc Ther. 2015 Aug;33(4):177–183.
Journal cover image

Published In

Cardiovasc Ther

DOI

EISSN

1755-5922

Publication Date

August 2015

Volume

33

Issue

4

Start / End Page

177 / 183

Location

England

Related Subject Headings

  • Warfarin
  • United States
  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Patient Selection
  • Medicare
  • Male
  • Humans