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By Eduardo Roque Cardiologista com foco em cardiologia hospitalar e cuidados intensivos. Professor de clínica médica.
Robyn Pauline Thom, Clare Kelleher Mock, Polina Teslyar
Consensus panel guidelines advocate for the judicious use of antipsychotic drugs to manage delirium in hospitalized patients when nonpharmacologic measures fail and the patient is in significant distress from symptoms, poses a safety risk to self or others, or is impeding essential aspects of his or her medical care. Here, we review the use of haloperidol, olanzapine, quetiapine, risperidone, and aripiprazole for this purpose.
August 2017: Cleveland Clinic Journal of Medicine
Yelena Tarasenko, Chen Chen, Nancy Schoenberg
OBJECTIVES: To examine adherence to the American College of Sports Medicine and American Cancer Society guidelines on leisure-time aerobic and muscle-strengthening physical activity (PA) of older cancer survivors. DESIGN: Cross-sectional study based on the 2014 National Health Interview Survey. SETTING: United States. PARTICIPANTS: Young-old (65-74) (n = 627), old-old (≥75) (n = 656), and middle-aged (45-64) (n = 786) cancer survivors and adults without cancer (n = 18,369), stratified according to the same age groups...
February 2017: Journal of the American Geriatrics Society
Masaharu Akao, Takeshi Yamashita, Ken Okumura
BACKGROUND: Apixaban, one of the non-vitamin K antagonist oral anticoagulants, was reported to be effective and safe in stroke prevention in patients with atrial fibrillation (AF) based on the global randomized clinical trial, but data are limited on the efficacy and safety of apixaban in Japanese elderly patients. METHODS AND RESULTS: The J-ELD AF Registry is a large-scale, contemporary observational study, continuously and prospectively registering elderly Japanese patients with AF aged 75 years or older who are currently taking apixaban or the elderly who are to receive apixaban in daily clinical practice, and accumulating the outcomes during one-year follow-up period...
December 2016: Journal of Cardiology
Kuan H Ng, Olga Shestakovska, Stuart J Connolly, John W Eikelboom, Alvaro Avezum, Rafael Diaz, Fernando Lanas, Salim Yusuf, Robert G Hart
BACKGROUND: increasing age is associated with a higher prevalence of atrial fibrillation (AF), and higher risks of stroke and bleeding. We report the effects of apixaban versus acetylsalicylic acid (ASA) in older patients (≥75 years and ≥85 years) compared with younger patients with AF unsuitable for vitamin K antagonists. METHODS: AVERROES (Apixaban Versus ASA to Prevent Stroke In AF Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) trial (n = 5,599) included 1,898 patients ≥75 years and 366 patients ≥85 years...
January 2016: Age and Ageing
Sigrun Halvorsen, Dan Atar, Hongqiu Yang, Raffaele De Caterina, Cetin Erol, David Garcia, Christopher B Granger, Michael Hanna, Claes Held, Steen Husted, Elaine M Hylek, Petr Jansky, Renato D Lopes, Witold Ruzyllo, Laine Thomas, Lars Wallentin
AIMS: The risk of stroke in patients with atrial fibrillation (AF) increases with age. In the ARISTOTLE trial, apixaban when compared with warfarin reduced the rate of stroke, death, and bleeding. We evaluated these outcomes in relation to patient age. METHODS AND RESULTS: A total of 18 201 patients with AF and a raised risk of stroke were randomized to warfarin or apixaban 5 mg b.d. with dose reduction to 2.5 mg b.d. or placebo in 831 patients with ≥2 of the following criteria: age ≥80 years, body weight ≤60 kg, or creatinine ≥133 μmol/L...
July 21, 2014: European Heart Journal
Manuj Sharma, Victoria R Cornelius, Jignesh P Patel, J Graham Davies, Mariam Molokhia
BACKGROUND: Evidence regarding the use of direct oral anticoagulants (DOACs) in the elderly, particularly bleeding risks, is unclear despite the presence of greater comorbidities, polypharmacy, and altered pharmacokinetics in this age group. METHODS AND RESULTS: We performed a systematic review and meta-analysis of randomized trials of DOACs (dabigatran, apixaban, rivaroxaban, and edoxaban) for efficacy and bleeding outcomes in comparison with vitamin K antagonists (VKA) in elderly participants (aged ≥75 years) treated for acute venous thromboembolism or stroke prevention in atrial fibrillation...
July 21, 2015: Circulation
Olivier Hanon, Patrick Assayag, Joel Belmin, Jean Philippe Collet, Jean Paul Emeriau, Laurent Fauchier, Françoise Forette, Patrick Friocourt, Armelle Gentric, Christophe Leclercq, Michel Komajda, Jean Yves Le Heuzey
Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient's functional status and social situation and the identification of co-morbidities...
May 2013: Archives of Cardiovascular Diseases
Fernando Veiga Fernández, María del Rocío Malfeito Jiménez, Sonia María Barros Cerviño, María del Mar Magariños Losada
Anticoagulation in elderly people with non-valvular atrial afibrillation (AF) is a challenge, due to the thromboembolic, as well as the haemorrhagic risks. The correct use of anticoagulants in these patients has shown a higher net clinical benefit when comparing it with a younger population. Non-vitamin K antagonist oral anticoagulants (NOACs) have been compared to oral vitamin K antagonists in several studies that included a sufficient number of elderly people. Favourable results for non-vitamin K antagonist oral anticoagulants were obtained in these studies, making them the preferred treatment for this group of patients...
May 2015: Revista Española de Geriatría y Gerontología
Stefano Barco, Yuk Wah Cheung, John W Eikelboom, Michiel Coppens
The new oral anticoagulants (NOACs) dabigatran etexilate, rivaroxaban, and apixaban have been extensively studied for prevention and treatment of venous thromboembolic disease and for stroke prevention in atrial fibrillation. Elderly patients have the highest incidence of thrombotic complications but also have the highest risk of anticoagulant associated bleeding. In this review we critically examine the balance between risks and benefits of NOACs compared with vitamin K antagonists in elderly patients enrolled in phase 3 randomized controlled trials for the management of venous thrombosis and stroke prevention in atrial fibrillation...
June 2013: Best Practice & Research. Clinical Haematology
Claudia Stöllberger, Josef Finsterer
The prevalence of atrial fibrillation (AF) and the embolic risk increase with age. Elderly AF patients are undertreated with vitamin K antagonists (VKA). The new oral anticoagulants (NOAC) dabigatran, rivaroxaban and apixaban have been shown to be non-inferior to VKA for stroke prevention in AF. We summarize the knowledge about primary and secondary stroke prevention by NOAC in AF patients >75 years of age. A literature search was carried out using the terms 'dabigatran', 'rivaroxaban', 'apixaban', 'elderly', 'octogenarians', 'atrial fibrillation' and 'anticoagulation' from 1998 to 2013...
December 2013: Drugs & Aging
Partha Sardar, Saurav Chatterjee, Shobhana Chaudhari, Gregory Y H Lip
OBJECTIVES: To evaluate the efficacy and safety of new oral anticoagulants (NOACs) in elderly adults. DESIGN: Meta-analyses of randomized clinical trials (RCTs). SETTING: PubMed, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched from January 1, 2001, through March 30, 2013. PARTICIPANTS: Elderly population (≥ 75) in RCTs comparing NOACs (rivaroxaban, apixaban, and dabigatran) with conventional therapy...
May 2014: Journal of the American Geriatrics Society
Amartya Kundu, Partha Sardar, Saurav Chatterjee, Wilbert S Aronow, Theophilus Owan, John J Ryan
Novel oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban have gained a lot of popularity as alternatives to warfarin for anticoagulation in various clinical settings. However, there is conflicting opinion regarding the absolute benefit of NOAC use in elderly patients. Low body mass, altered body composition of fat and muscle, renal impairment and concurrent presence of multiple comorbidities predispose elderly patients to many adverse effects with NOACs that are typically not seen in younger patients...
July 2016: Drugs & Aging
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