Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 601

Sometimes, starting long‐term anticoagulation in an elderly patient is a complicated decision. In major functional impairment or when life expectancy is short, the benefit that anticoagulation could offer as primary prevention is questionable.

On the other hand, acetylsalicylic acid has been classically considered an alternative to anticoagulation, especially in older patients (regardless of function), in hopes of minimizing the risk of bleeding. There is no current evidence to recommend using salicylic acetic acid in the primary prevention of patients with AF or as a prescription after initial anticoagulation in patients with VTE, and its use is associated with an increased risk of bleeding.^15,54

Older patients need closer monitoring during the first month of anticoagulation because the risk of bleeding is higher in this period.^55‐57 The elderly are at high risk of over‐anticoagulation at this time, particularly if standard rather than tailored induction doses are used. Siguret et al. have sought to develop a regimen for patients over 70,⁵⁸ giving 4 mg daily of warfarin for three successive days and the daily maintenance dose according to an algorithm; they found this protocol safe and accurate in elderly hospitalized patients.

A crucial point to be considered is the patient’s preferences. It is important to explain the risks and benefits of anticoagulation. Providing adequate information and taking into account their opinion and preferences will result in better treatment adherence and thus fewer side effects.⁵⁹ In a recent study carried out in Spain, patients taking DOACs (versus VKAs) showed lower perceived burdens and higher perceived benefits with anticoagulation, regardless of many clinical variables including age, sex, level of dependency, renal function, number of pills, thromboembolic or bleeding risk, comorbidities, and duration of treatment with anticoagulants.⁶⁰