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Three-pronged attack on NICE challenges hypertension advice

The benefits of moderately vigorous anticoagulant treatment outweigh the risks in the very elderly, but intense treatment should be avoided, according to a new study.

Doctors should aim for an INR range of 2.0 or 3.0 when prescribing warfarin, even for older patients, the researchers said.

Researchers found the risk of intracranial haemorrhage in patients over 85 was not significantly higher at INRs between 2.0 and 3.0 than at ratios below 2.0.

Overall the risk of bleeding was 2.5 times higher in patients over 85 than in younger patients. Pushing INRs beyond 3.0 produced dangerous levels of adverse events, with the risk of bleeding increasing by 4.5 times.

Study leader Professor Margaret Fang, assistant professor of medicine at the University of California, said: 'Although we found people aged 85 and older had a higher risk of intracranial haemorrhage, these are also the patients who gain the greatest benefit from warfarin for stroke prevention.

The study, published in Annals of Internal Medicine (November) analysed data from atrial fibrillation patients with or without haemorrhage.

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