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Over 80s miss out on warfarin therapy

Elderly patients are missing out on warfarin therapy even after taking into account that their age puts them at higher risk of bleeding say UK researchers.

Reticence to start them on the anticoagulation treatment seems to be based on age and independent of stroke or bleeding risk, the General Practice Research Database analysis suggested.

A study of patients over 60 with newly diagnosed atrial fibrillation showed that those aged 80 or older were significantly less likely to receive warfarin therapy.

The data from more than 81,000 patients diagnosed between 2000 and 2009 found only a third of patients aged over 80 were put on warfarin compared with 57% of those in their 60s and 55% of those in their 70s.

Categorising the patients by stroke risk bleeding risk showed that the very elderly were significantly less likely to be prescribed warfarin regardless of whether the benefits outweighed the risks.

The University of Cambridge researchers also showed that women, those with a low basal metabolic index, dementia, and higher bleeding risk scores were less likely to be started on the anticoagulant.

Writing in the Heart journal, they concluded that age is the single biggest reason for whether or not a patient with atrial fibrillation is given warfarin.

‘The low use of warfarin in people aged 80 years is not explained by increased comorbidity or increased bleeding risk.

‘Strategies need to be developed to improve the uptake of anticoagulation in this age group.’

Source: The Heart, online 19 October