Electronic letters to:

Research:
Natalie Oake, MSc, Alison Jennings, MA, Alan J. Forster, MD MSc, Dean Fergusson, PhD, Steve Doucette, MSc, and Carl van Walraven, MD MSc
Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis
CMAJ 2008; 179: 235-244 [Abstract] [Full text] [PDF]
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[Read eLetter] Anticoagulation is indicated in all patients with high risk of thromboembolism regardless of age
Radhakrishnan Ramaraj   (12 August 2008)

Anticoagulation is indicated in all patients with high risk of thromboembolism regardless of age 12 August 2008
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Radhakrishnan Ramaraj
University of Arizona College of Medicine

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Re: Anticoagulation is indicated in all patients with high risk of thromboembolism regardless of age

drkutty2{at}gmail.com Radhakrishnan Ramaraj

Oake and colleagues have done an excellent metanalysis to demonstrate that thromboembolic events were reduced at increased INR.(1) I would like to emphasize another important point; there has always been a debate about starting and maintaining anticoagulation in older people who are at risk of thromboembolism, as it was previously preached that elderly have increased risk of bleeding with anticoagulation. There are studies which have shown that bleeding pattern was similar in all age groups in respects to severity, onset, anatomic site of bleeding, and INR values during the bleeding event.(2) In another study on a elderly population demonstrated that patients whose high level of dependency( housebound) who required domiciliary monitoring were at greatest risk of warfarin-related bleeding, but increasing age had no independent effect.(3) Therefore the message should be clearly amplified informing that the patients who are at high risk of thromboembolism should anticoagulated adequately regardless of age.

References:

1.Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, van Walraven C. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta- analysis. CMAJ 2008;179:235-44.

2.Abdelhafiz AH, Wheeldon NM. Risk factors for bleeding during anticoagulation of atrial fibrillation in older and younger patients in clinical practice. Am J Geriatr Pharmacother 2008;6:1-11.

3.Goudie BM, Donnan PT, Fairfield G, Al-Agilly SS, Cachia PG. Dependency rather than old age increases the risk of warfarin-related bleeding. Br J Gen Pract 2004;54:690-2.

Conflict of Interest:

None declared