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Title ANTICOAGULATION IN OLDER ADULTS |
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Type Free Paper Session 5 |
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Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
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Topic Heart Failure / Cardiovascular Rehabilitation & Preventive Cardiology |
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Main Author Siti Shafia Bte Yang Razali1 |
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Presenting Author Sher Yin Tan1 |
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Co-Author Zi Huan Mok1 Sher Yin Tan1 Barbara Helen Rosario1 |
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Department / Institution / Country Geriatric Medicine / Changi General Hospital / Singapore1 |
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Objective(s) Many elderly patients are on oral anticoagulants. Oral anticoagulants are high risk medications and the decision to start or stop in the elderly can be difficult. There are variations in prescribing practices and systems. We aimed to investigate the prescribing practices in our institution and determine whether Direct Oral Anticoagulants (DOACs) are becoming standard of care in older patients. |
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Material and Method A retrospective audit was undertaken of 143 individual prescriptions of oral anticoagulants (predominantly in-patient) by the Geriatric Department between end 2015 and beginning 2017. Electronic records were reviewed and demographic data extracted for the following: indication for anticoagulation, whether patients were still on anticoagulation at time of analysis, the teams that initiated and followed up treatment and handover processes. Where anticoagulation treatment had been interrupted or stopped, we searched for documented reasons for interruption. We also looked at frequency of INR and kidney function monitoring, as well as default rates and mortality. |
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Result(s) The average age was 82.8 years (age range 67-97) and 69% were female and 31% male. Race distribution was 75% Chinese, 20% Malay, 3% Eurasian, 2% Indian. The majority of patients (83%) were on anticoagulation for atrial fibrillation. Of the anticoagulants, 53% were on warfarin and 47% were on DOACs (27% rivaroxaban, 15% apixaban and 5% dabigatran). Anticoagulant treatment was stopped at some point in 45% of patients. Mortality in the cohort was 36% and predominantly from pneumonia rather than cardiovascular causes, although cause of death was not available for all patients. |
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Conclusion Almost half of this cohort was on DOACs but warfarin is still utilized more commonly in advanced age. A large proportion of patients had their treatment interrupted or stopped and mortality was predominantly from non-cardio vascular causes. This audit identified a need for more robust follow up systems for older patients on anticoagulants. |