Huw
Briefly
-no studies include patients that old AFAIK
-risk of thromboembolism in valvular heart disease (M stenosis - not simply
prolapse) higher than AF with OK valves (sorry can't quote ref just now).
Other stroke risk assessment (eg cardiac failure, hypertension, diabetes)
not evaluated in pts with valve disease.
-elderly annual major bleed risk over 75 in SPAF2 = 4% pa - roughly matches
Leiden outpatient anticoag data. Risk certainly increases abover INR of 3,
posssibly even within INR 2-3 range
-drug interactions (especially paracetamol!), GI upsets other acute
illnesses common associated factors in high INRs / bleeds (ref not handy but
NEJM earlier this year)
-patient cognition may well be important check clearly understands separate
doses eg 1mg / 3mg, can read labels on bottles, etc (see Sudlow, Thomson,
Kenny BMJ early this year)
- patient attitudes and resources (eg if need home INRs) must be important
Even more briefly - there is inadequate evidence to make firm
recommendations.
Anecdotally the key factor in successful warfarin in the over 80s is being
so frail that a home help calls at tea-time (so can remind / check re
medication) as in my experience it contains difficult concepts for any but
the sharpest older minds to grasp.
Hope this helps
Chris
Dr Chris Burton
GP, Sanquhar, Dumfriesshire
Member of WestNet, The West of Scotland Primary Care Research Network
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Huw
> Thomas
> Sent: 21 October 1998 11:12
> To: [log in to unmask]
> Subject: 86 yr old with AF
>
>
> I need to do a risk assessment - 86 year old with Af and valvular heart
> disease -
>
> warfarin ?? Pro's and cons Can anyone point me at some good resources?
> Last minute tutorial stuff again!!!
>
> Huw thomas
>
> GP Somerset UK
> --
> Huw Thomas
>
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