Patients with AF who remained within the INR2-3 therapeutic range for more than 70% of the anticoagulation time had nearly an 80% reduction in the risk of stroke ( 9). Previous studies have demonstrated the efficacy and safety of chronic oral anticoagulation with warfarin in elderly patients by adopting an INR range between 2 and 3 (INR2-3). According to this increased bleeding risk in the elderly, physicians may tolerate nontherapeutic INR levels or prescribe lower doses of warfarin than the nonelderly would receive, which leads to a bias that favors inadequate and ineffective anticoagulation ( 8). For example, intracranial bleeding occurs more frequently in very elderly patients (≥85 years) and those with an INR value >3.5 ( 7). It is known that elderly patients are more likely to experience both thromboembolic events and bleeding, even when they are within the therapeutic range of anticoagulation ( 6). Currently, oral anticoagulation therapy with warfarin requires regular control of the levels of anticoagulation based on an international normalized ratio (INR) between 2 and 3 (INR2-3) ( 5). However, only half of the patients with AF are within the therapeutic range of anticoagulation, whereas the other half does not use oral anticoagulants ( 3) or are inadequately anticoagulated ( 4). Oral anticoagulation therapy with warfarin is highly effective for the prevention of thromboembolic events ( 1, 2). Stable anticoagulation was achieved in 80% of patients who received doses of 2 to 5 mg/day of warfarin, and the mean daily dose was similar across the age groups analyzed.Ĭhronic atrial fibrillation (AF) is more prevalent in the elderly population and serves to increase the risk of thromboembolic events. The correlation between the daily warfarin dose and the international normalized ratio was 0.22 ( p = 0.012). The patients were stratified according to the following age groups: 5.0 mg/day. The international normalized ratio was measured in the central laboratory using the traditional method. We analyzed 112 consecutive outpatients with atrial fibrillation who were ≥65 years of age, had received anticoagulation therapy with warfarin for more than 1 year and had a stable international normalized ratio between 2.0 and 3.0 for ≥6 months. The aim of this study was to analyze the warfarin dose necessary for the maintenance of stable oral anticoagulation therapy in elderly patients. However, the dosage required to achieve stable anticoagulation remains unknown. Stable anticoagulation is defined as the time within >70% of the therapeutic range. 2, 3 However, the single prospective randomized trial on this topic followed 363 patients for two years and found no difference in complications or time spent in the therapeutic range.Anticoagulation is a challenge for the prophylaxis of thromboembolic events in elderly patients with chronic atrial fibrillation. Two trials using a before-and-after design (which is still more subject to bias than a prospective randomized trial) found more hemorrhages and recurrent thromboembolia in the usual care group than in the group managed by AMS. Large-scale randomized controlled trials with an appropriate duration of follow-up are lacking. When patients can choose whether to attend an AMS or get usual care, it is possible that more motivated, compliant patients are attracted to the AMS. 1 However, most studies were small, and many were non-randomized. A systematic review of the evidence found some support for AMS and PSM over usual care because of increased patient time in the therapeutic range and fewer bleeding complications. Two alternatives to managing anticoagulation in the primary care office are using anticoagulation management services (AMS) and patient self-monitoring (PSM), which relies on home testing of the INR.
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