Quality of oral anticoagulation treatment in real-life practiceand factors associated with optimal therapeutic responsein elderly patients
2010
Introduction. Oral anticoagulation therapy (OAT) is recommended in several
cardiovascular disorders and is increasingly used in elderly patients. Obtaining
a stable value of International Normalized Ratio (INR) within the target levels
may however represent a difficult goal, in this population. Indeed, there is suggestion
that out of range INR values are frequently seen in clinical practice.
This fact may be associated with serious adverse events such as bleeding and
thromboembolic disorders, which may be often fatal in elderly people. Aim of
the present study was to evaluate the factors associated with an increased risk
of out of range INR levels in this subgroup of patients.
Methods. Consecutive patients admitted to the Emergency Department of two
Italian Institutions were analyzed within two hours of their admission. Only
patients 70 years or older were eligible for the study.
Results. 242 patients were enrolled, 151 of whom (62.4%) with abnormal values.
When comparing the characteristics of those within or outside the normal
range, it appeared that the former had a higher educational level (27% vs 5%)
and more frequently a duration of treatment longer than 5 years (62% vs 27%):
OR=7.36; 95% C.I. 3.02-17.95; p < 0.0001, and OR=4.29; 95% C.I. 2.46-7.47;
p < 0.0001, respectively.
Discussion. The majority of patients in this sample of elderly patients seem unable
to maintain optimal INR values. The risk seems higher in patients with a
low level of education and with less than 5 year OAT.
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