Summary
Oral anticoagulant therapy has been shown to be of benefit also in elderly patients in various therapeutic and prophylactic indications. Despite strong evidence in literature, doctors still refuse to prescribe oral anticoagulants to geriatric patients in daily routine. Main reason for this decision is the fear of secondary bleeding complications. According to clinical trial data, distinct risk factors for bleeding attributed to anticoagulant treatment may be determined: age >70 years, female gender, recurrent bleeding events, alcohol/drug abuse, diabetes, anaemia and polypharmacy. The entire article reveals the literature in Medline and Cochrane Library from 1980 to 2009 including the hits "polypharmacy – anticoagulant treatment – elderly patients". It further highlights risk assessment strategies in elderly patients, and possible pharmacokinetic and -dynamic interactions of drugs co-administered with oral anticoagulants.
Zusammenfassung
Die orale Antikoagulation (OAK) geriatrischer Patienten wird therapeutisch und prophylaktisch weltweit im Rahmen einer Vielzahl von Indikationen eingesetzt. Vor allem bei hochaltrigen Patienten schrecken viele KollegInnen vor einer Verschreibung von oralen Antikoagulantien mit der Angst vor sekundären Blutungen zurück. Aus den vorliegenden Studien lassen sich mehrere Faktoren für die Entwicklung eines Blutungsrisikos unter OAK ermitteln. Dazu zählen mit unterschiedlicher klinischer Wertigkeit ein Patientenalter >70 Jahre (mit einer linear steigenden Tendenz mit dem fortschreitenden Lebensalter), das weibliche Geschlecht, wiederholte Blutungsereignisse, eine rezent zurückliegende Blutung, Alkohol- oder Medikamentenmissbrauch, der Diabetes mellitus, eine vorbestehende Anämie sowie die Polypragmasie. Die vorliegende Arbeit beschäftigt sich unter Durchsicht der aktuell über Medline und die Cochrane Library im Zeitraum 1980 bis 2009 verfügbaren Arbeiten zum Thema "Antikoagulation – Polypragmasie – geriatrische Patienten" mit Risikoassessmentstrategien und beleuchtet im Speziellen pharmakokinetische und pharmakodynamische Interaktionen von Medikationen mit oralen Antioagulantien.
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Roller, R., Iglseder, B., Dovjak, P. et al. Blutungskomplikationen bei geriatrischen Patienten unter oraler Antikoagulation – Aspekte der Polypragmasie. Wien Med Wochenschr 160, 270–275 (2010). https://doi.org/10.1007/s10354-010-0785-2
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DOI: https://doi.org/10.1007/s10354-010-0785-2