La fibrillation atriale chez la personne âgée : actualités de la prise en charge thérapeutique selon les dernières recommandations (2012) de la Société européenne de cardiologie : focus sur le traitement anticoagulant

摘要

Atrial fibrillation (AF) is the most frequently seen heart problem among elderly people. It is associated with an increased risk of cerebral vascular accidents (CVA), cardiac decompensation, worsened quality of life and increased mortality. The prevention of cardio-embolic CVAs secondary to AF therefore represents a major challenge to public health. For several decades now, oral anticoagulants (vitamin K antagonists) have been shown to have a favourable benefit/ risk ratio for the prevention of cardio-embolic CVAs, especially among elderly people who present a higher risk of a CVA with the presence of AF, compared to younger patients. However, around 30% of elderly patients with AF do not receive anticoagulant treatment, with no apparent contraindications. New recommendations from the European Cardiology Society published in 2012 favour the introduction of anticoagulant treatment (vitamin K antagonists or new anticoagulants [NACO] with a CHA2DS2-VASc score equal to 1 [except for women under the age of 65 with an isolated AF]). NACOs are now indicated in first intention following the results of a number of non-inferiority tests versus coumadin. Please note that none of these tests have yet included a wide range of patients over the age of 80, or with multiple pathologies, multiple medical problems or presenting geriatric syndromes. In these elderly demographics, care is therefore taken (first do no harm) regarding the prescription of NACOs where the elderly patients in question have a low body weight and/or altered kidney function.