Anticoagulação oral nos muito idosos e seus determinantes clínicos

Abstract

ORAL ANTICOAGULATION THERAPY IN ELDERLY PATIENTS Objectives: To determine the frequency of anticoagulation therapy among patients over 80 years of age registered in a Family Health Unit, to analyze factors associated with this treatment, and to characterize patients with atrial fibrillation using the CHA2DS2VASc and HAS-BLED scales. Type of study: Cross-sectional. Location: Maia Family Health Unit, Portugal. Population: All patients over 80 years old registered in this Family Health Unit. Methods:We studied the electronic medical records of a random sample of elderly patients. We recorded the patients’ age, gender, prescription of oral anticoagulants and antiplatelet agents, indications and contraindications for anticoagulation, the presence of cardiovascular diseases, blood pressure and body mass index. Results: The records of 266 patients were selected for study out of the 609 records of patients over 80 registered in this clinic. The frequency of anticoagulation was 6.8% (95% CI: 3.7 to 9.8%). Anticoagulation was associated with the diagnosis of atrial fibrillation, pulmonary embolism, peripheral arterial disease, heart failure and acute myocardial infarction. Of the 31 patients with atrial fibrillation, 35.5% were receiving anticoagulation therapy, 9.7% had both anticoagulation and antiplatelet therapy, 45.2% used antiplatelet therapy and 9.7% were not receiving any antithrombotic therapy. All patients with atrial fibrillation had indications for anticoagulation. Conclusions: The frequency of anticoagulation among very elderly patients in this family health unit is high. Atrial fibrillation was the most common indication. Most individuals with atrial fibrillation were receiving antithrombotic therapy but the proportion of anticoagulant users was less than expected, based on the use of thrombosis and bleeding risk scales.