Are geriatric syndromes associated with reluctance to initiate oral anticoagulation therapy in elderly adults with nonvalvular atrial fibrillation?

摘要

To the Editor: Age is associated with risk of atrial fibrillation. (AF) and its consequences, including stroke. In turn, stroke has been associated with mortality, disability, and health-related quality of life. The American Association of Chest Physicians states that anticoagulation therapy (AT) must be initiated in individuals with nonvalvular AF in moderate- and high-risk categories for the development of stroke (according to congestive heart failure, hypertension, aged >75, diabetes mellitus, stroke, vascular disease, aged 65-74, sex (CHA_2DS_2VASc) score), whereas a variety of major bleeding prediction scores, such as the hypertension, abnormal (renal/liver function), stroke, bleeding tendency, labile international normalized ratio, elderly, drugs (HAS-BLED) have been developed to aid in the decision-making process in relationship to prescribing AT. Nevertheless, recent work has shown that the net clinical benefit favors the initiation of AT over the risk of major bleeding, even in individuals at high risk of bleeding.