Anticoagulation in frail older people
Sarah Damanti1
Simon Braham2
Luca Pasina3
1.Geriatric Unit,IRCCS Ca'Granda Ospedale Maggiore Policlinico,Milan,Italy;Univeristy of Milan,Milan,Italy 2.Angelo Bianchi Bonomi Hemophilia and Thrombosis Center,IRCCS Cà Granda Maggiore Hospital Foundation,Milan,Italy 3.Pharmacotherapy and Appropriateness of Drug Prescription Unit,Istituto Di Ricerche Farmacologiche Mario Negri IRCCS,Via Giuseppe La Masa,Milan,Italy
摘要：Frailty is a multidimensional dynamic condition charac-terized by decreased physiological reserves.
Therefore ，frail people are more vulnerable to stressors.Indeed, minor stimuli, like a new drug prescription, can alter their homeostatic equilibrium determining adverse clinical outcomes (i.e., falls, institutionalization, disability,and death).[1 ,2] Since the risk of atrial fibrillation[3] and venous thromboembolism[4] increase with ageing ，frail people might require long term anticoagulation. On the other side,anticoagulated patients have also an increased bleeding risk and such complication is more frequent in the elderly. For these reasons, prescribing anticoagulant treatment in frail people is challenging and many patients remain untreated despite the c1inical indication. Comorbidities, in particular renal and liver insufficiency, polypharmacy, reduced compliance to medications, anticoagulant dose adjustment errors, falls and a greater susceptibility to gastrointestinal haemorrhages further complicate their management. [5] Hence, a correct balance of the risks should be performed. Ad hoc scores have been elaborated (i.e.CHA2DS2-VASc score[6] for the thrombotic risk and HAS-BLED score[7] for the haemorrhagic risk) and are routinely used in c1inical practice.Unfortunately,both scores share many criteria (age, hypertension,and previous stroke) making treatment decision more difficult.
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论文发表日期：2019-11-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：3( 844-846 )
英文信息