Objective:

The goals of this study were to analyze the type of antithrombotic treatment administered to institutionalized patients with nonvalvular atrial fibrillation (and any ensuing complications) and to evaluate the degree of anticoagulation control achieved with vitamin K antagonists.

Method:

This was a prospective observational follow-up study carried out in seven elderly care facilities during 2016. Patients with nonvalvular atrial fibrillation were evaluated for their antithrombotic therapy and any embolic or hemorrhagic events, as well as for mortality. Subjects on anticoagulation treatment with VKAs were evaluated for anticoagulation control, with control considered poor if the mean time in therapeutic range was < 65% when measured with Rosendaal’s method or < 60% when determined by the direct method.

Results:

Of the 699 residents evaluated, 20.6% had a diagnosis of NVAF. Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2-VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04) risk were high. Fifty percent received anticoagulation treatment, mainly with vitamin K antagonists, of whom at least 56% were not within the therapeutic range. Sixteen percent of the residents, the oldest and most functionally and cognitively dependent ones, had not been prescribed any antithrombotic therapy. A higher frequency of hospital admissions induced by cardiovascular and bleeding events was found in these residents, although differences were not statistically significant.

Conclusions:

Half of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet therapy, and some without any antithrombotic treatment. This study showed that as functionality decreases, treatment strategies are increasingly aimed at therapeutic deintensification. Given that the degree of anticoagulation control with vitamin K antagonists is inadequate in 56% of cases, it is essential to monitor the time in therapeutic range to optimize treatment as needed.