Selecting a direct oral anticoagulant for the geriatric patient with nonvalvular atrial fibrillation

Anirudh Srikonda, Brittny A. Rule, Michael Toscani, Christopher D. Adams, Luigi Brunetti

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Objective: To provide a clinical summary of the available data evaluating the use of direct oral anticoagulants (DOACs) in geriatric patients with nonvalvular atrial fibrillation. Methods: MEDLINE, Web of Science, and Google Scholar were used to identify pertinent systematic reviews, randomized controlled trials, observational studies, and pharmacokinetic studies evaluating use of DOACs in the geriatric population. Results: A total of 8 systemic reviews, 5 randomized controlled trials, 2 observational trials, and 5 pharmacokinetic studies of relevance were identified for inclusion in this review. The landscape of anticoagulation has dramatically changed over the past 5 years beginning with the development and marketing of an oral direct thrombin inhibitor and followed by 3 oral direct factor Xa inhibitors. Despite significant advances in this oral anticoagulation arena, many questions remain as to the best therapeutic approach in the geriatric population as the literature is lacking. This population has a higher risk of stroke; however, due to the increased risk of bleeding clinicians may often defer anticoagulant therapy due to the fear of hemorrhagic complications. Clinicians must consider the risk-benefit ratio and the associated outcomes in geriatric patients compared to other patient populations. Conclusions: Interpreting the available literature and understanding the benefits and limitations of the DOACs is critical when selecting the most appropriate pharmacologic strategy in geriatric patients.

Original languageEnglish (US)
Pages (from-to)550-564
Number of pages15
JournalJournal of Clinical Outcomes Management
Volume22
Issue number12
StatePublished - Dec 1 2015

All Science Journal Classification (ASJC) codes

  • Health Policy

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