Use of Vitamin K Antagonist Therapy in Geriatrics: A French National Survey from the French Society of Geriatrics and Gerontology (SFGG)

• Published in: Drugs & aging Vol. 30; no. 12; pp. 1019 - 1028
• Main Authors: Plichart, Matthieu, Berrut, Gilles, Maubourguet, Nathalie, Jeandel, Claude, Emeriau, Jean-Paul, Ankri, Joël, Bouvier, Hélène, Ruault, Geneviève, Hanon, Olivier
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2013; Adis International; Springer Nature B.V
• Subjects: Aged, 80 and over; Antibiotics; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Atrial Fibrillation - blood; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac arrhythmia; Cross-Sectional Studies; Drug Utilization Review - statistics & numerical data; Female; France; Geriatrics; Geriatrics/Gerontology; Gerontology; Heart; Hospitalization; Humans; Institutionalization; Internal Medicine; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Morbidity; Nursing care; Nursing homes; Original Research Article; Patients; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pharmacotherapy; Prostheses; Rehabilitation; Societies, Medical; Stroke; Surveys and Questionnaires; Thromboembolism; Vitamin K - antagonists & inhibitors; France; Europe; International Normalize Ratio; Rehabilitation Care; Warfarin; Prosthetic Heart Valve; Atrial Fibrillation; Human; Antivitamin K; Gerontology; Treatment; Anticoagulant; Review; Elderly; Public health; Geriatrics
• ISSN: 1170-229X; 1179-1969
• DOI: 10.1007/s40266-013-0127-3

Objective We aimed to evaluate the quality and determinants of vitamin K antagonists (VKA) control among very elderly patients in geriatric settings. Methods A national cross-sectional survey was conducted among patients aged ≥80 years who were hospitalized in rehabilitation care or institutionalized in a nursing home and who were treated by VKA. Time in therapeutic range (TTR) was computed according to Rosendaal’s method. Results A total of 2,633 patients were included. Mean [± standard deviation (SD)] age was 87.2 ± 4.4 years and 72.9 % were women. The main indication for VKA therapy was atrial fibrillation (AF; 71.4 %). Mean (±SD) TTR was 57.9 ± 40.4 %. After backward logistic regression, poorer VKA control (TTR <50 vs. ≥50 %) was associated with being hospitalized in rehabilitation care [odds ratio (OR) rehab. vs. nursing home  = 1.41; 95 % CI 1.11–1.80], the indication for VKA treatment (OR prosthetic heart valve vs. AF  = 4.76; 95 % CI 2.83–8.02), a recent VKA prescription (OR <1 vs. >12 months  = 1.70; 95 % CI 1.08–2.67), the type of VKA (OR fluindione vs. warfarin  = 1.22; 95 % CI 1.00–1.49), a history of international normalized ratio >4.5 (OR = 1.50; 95 % CI 1.21–1.84), a history of major bleeding (OR = 1.88; 95 % CI 1.00–3.53), antibiotic use (OR = 1.83; 95 % CI 1.24–2.70), and falls (OR ≥2 falls during the past year vs. <2  = 1.26; 95 % CI 1.01–1.56). Conclusion Overall, VKA control remains insufficient in very old patients. Poorer VKA control was associated with taking VKA for a prosthetic heart valve, a recent VKA prescription, the use of other VKAs than warfarin, a history of overcoagulation and major bleeding, antibiotic use, and falls.