make a situational diagnosis based on the patient’s functionality and disease status. In patients with a poor prognosis approaching the end of life, the risks and burdens of anticoagulation may exceed the perceived benefits, in which case discontinuation of therapy may be appropriate.
Key points
When used appropriately, anticoagulants are highly effective drugs in the elderly. Age 85 or older may be an additional risk indication for anticoagulation.
The selection of the anticoagulant drug and its dose should be carried out individually and carefully, taking into account clinical geriatric criteria and patient preferences. Evidence suggests that patients with a greater burden of comorbidities appear to spend less time within the therapeutic international normalized ratio (INR) range, resulting in a lower quality of anticoagulation therapy.
It seems reasonable that patients who do not receive anticoagulant therapy should be limited to those with an obvious contraindication and those with a poor prognosis at the end of life.
In patients >75, DOACs as a class were superior to warfarin with respect to both efficacy and safety, showing similar efficacy in the prevention of stroke and systemic embolization. Apixaban had the lowest risk of major bleeding, and apixaban, edoxaban, and dabigatran had lower rates of intracranial haemorrhage than rivaroxaban or warfarin.
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