Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Multidisciplinary Consensus Document.
Marco ProiettiMarina CameraMaurizio GallieniLuigi GianturcoAntonio GidaroCarlo PiemonteseGiuseppe PizzettiFranco RedaelliBarbara ScimecaCarlo Sebastiano TadeoBeatrice ArosioGiuseppe BellelliLaura Adelaide Dalla VecchiaPublished in: Journal of personalized medicine (2022)
In the last twelve years the clinical management of patients with atrial fibrillation has been revolutionised by the introduction of direct oral anticoagulants. Despite the large amount of evidence produced, some populations remain relatively poorly explored regarding the effectiveness and safety of direct oral anticoagulants, such as the oldest and/or frailest individuals. Frailty is clinical syndrome characterized by a reduction of functions and physiological reserves which results in individuals having higher vulnerability. While current evidence underlines a relationship between atrial fibrillation and frailty, particularly in determining a higher risk of adverse outcomes, data regarding effectiveness and safety of direct oral anticoagulants in frailty atrial fibrillation patients are still lacking, leaving uncertainty about how to guide prescription in this specific subgroup. On these premises, this multidisciplinary consensus document explains why it would be useful to integrate the clinical evaluation performed through comprehensive geriatric assessment to gather further elements to guide prescription of direct oral anticoagulants in such a high-risk group of patients.
Keyphrases
- direct oral anticoagulants
- atrial fibrillation
- venous thromboembolism
- end stage renal disease
- community dwelling
- left atrial
- chronic kidney disease
- newly diagnosed
- oral anticoagulants
- catheter ablation
- left atrial appendage
- ejection fraction
- clinical evaluation
- prognostic factors
- peritoneal dialysis
- randomized controlled trial
- clinical trial
- percutaneous coronary intervention
- machine learning
- patient reported outcomes
- mitral valve
- acute coronary syndrome
- clinical practice
- open label
- deep learning
- patient reported