[Use of anticoagulant treatments in the elderly]

Management of Acenocoumarol in Tunisian elderly population : Risk factors of overdose and bleeding

INTRODUCTION

Anticoagulant therapy, often required in the elderly, is not without risk. This study aims to investigate the particularities of the use of anticoagulants in the elderly during hospital stay, along with the factors associated with bleeding and overdose.

RESULTS

There were 55 women and 45 men (sex ratio: 0.81), with a mean age of 75.7 ± 6.9 years. The indications for anticoagulant treatment were venous thromboembolism (VTE) (92%) and atrial fibrillation (AF) (8%). The average duration of treatment with acenocoumarol was 17.22 days ± 7.9. The dose of acenocoumarol initiation was 1 mg in 85% of patients and 2 mg in 15%. INR < 2 was observed in 15% of patients. INR in the target area was obtained in 47% of patients with a mean dose of 2.33 mg of acenocoumarol. An overdose of acenocoumarol was noted in 38% of patients: average INR at 4.7. Seven patients had bleeding events. An overdose was reported in 4 of them. Fever, infection, inflammatory syndrome, hypoalbuminemia, hypoprotidemia, and malnutrition were associated with a greater risk of overdose in our patients. Gastroduodenal ulcer disease, past medical history of gastrointestinal bleeding and renal failure were risk factors for bleeding in our patients.

CONCLUSION

The use of anticoagulants in the elderly requires a comprehensive assessment, including comorbidities, geriatric settings, and social environment.

[A tool for improving the transition between hospital and community care for the elderly]

The hospital-community interface represents a real challenge in the care of elderly people. A lack of coordination and communication is the main obstacle to ensuring the fluidity of this pathway. On a definite territory, a new hospital-community liaison sheet was developed as the result of a collaborative approach and then evaluated. This simple, useful and effective cross-professional tool, is the first step towards improving communication between these two universes.

[Risk factors of serious bleeding among ambulatory patients taking antivitamin K aged 75 and over]

The benefits of anti-vitamin K (AVK) drugs have been acknowledged in several indications. Such indications increasing with increasing age, AVK prescriptions also increases with age. At the same time, conditions involving significant bleeding are common in this elderly population. It is thus essential to recognize the determining factors. This study included all patients taking AVK drugs aged 75 years and older who sought emergency care at the Cochin Hospital from January to December 2011 for significant bleeding. These patients were compared with a cohort of patients aged 75 years or older who were taking AVK drugs and who were admitted to the same unit during the same time period for other reasons. The case-control comparison included demographic data, comorbidity factors, multiple medications, emergency measured INR, and CHA2DS2VASC level. The hemorrhagic risk was evaluated by HEMORR2HAGES and HAS-BLED. A total of 34 patients were studied and compared with 70 case-controls. The Charlson comorbidity index was higher in patients than case-controls (P<0.05), with a much higher hemorrhagic risk for scores ≥ 9 (OR=2.5; P<0.05). Multiple medication was also more predominant in patients (P<0.05). The risk of serious hemorrhage was also higher when the hemorrhagic scores were high, especially for HEMORR2HAGES (P<0.0001) and HAS-BLED (P<0.001). The risk of serious hemorrhage in elderly outpatients taking AVK drugs is related to their higher comorbidity and hemorrhagic levels which need to be evaluated before starting or stopping AVK treatment.