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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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32. Cardiovascular Nursing
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Long-term experience of non-vitamin K oral anticoagulants in elderly patients with atrial fibrillation
Session:
Posters - P. Other
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2021
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
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Session Type:
Posters
FP Number:
---
Authors:
João Pedro Reis; Pedro Silva Cunha; André Monteiro; Paula Malveiro; Mário Oliveira; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"inherit","serif""><span style="color:black">Background: Current guidelines recommend non-vitamin-K oral anticoagulants (NOACs) as the mainstay for stroke prevention in patients (P) with nonvalvular atrial fibrillation (AF). Appropriate NOAC treatment in very elderly P with AF is challenging because of concerns regarding frailty and bleeding complications. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"inherit","serif""><span style="color:black">Aim: To evaluate the experience with use of NOACs in a large elderly population from a dedicated NOAC clinic. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"inherit","serif""><span style="color:black">Methods: A single-centre prospective study was conducted among all P with AF followed in a dedicated NOAC clinic from a tertiary hospital between 2017 and 2020. P with ≥75 years of age were considered as very elderly. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"inherit","serif""><span style="color:black">Results: A total of 418P (age 77.9±10,3 years, 54.5% male, mean CHA2DS2-VASc score 3.9±1.4) were enrolled, with a mean follow-up of 51.2±35.7 months. There were 289P (69.1%) with ≥75 years of age with a mean CHA2DS2-VASc score of 4.3±1.2, of which 102P (24.5%) were ≥75 years. During follow-up, 30P experienced a minor hemorrhagic event (80% with ≥75 years) and 15P a major hemorrhagic event (73,3% with ≥75 years). There were 36 deaths, the majority (94%) in patients who were ≥75 years. A total of 11P had a stroke/systemic embolism (91% with ≥75 years). There was a total of 59 all-cause hospital admissions, all of which in the very elderly group. Temporary NOAC cessation was required in 87P (21%), mostly due to planned/ unplanned surgical interventions and endoscopic procedures. According to renal function, weight and age, a discrepancy was observed in dosing regarding pharmacological recommendations in 4% of the P. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="font-family:"inherit","serif""><span style="color:black">Conclusion: This report on real-world long-term clinical experience with NOACs </span></span><span style="color:black">found to be safe and efficacious among high-risk elderly patients. A structured follow-up, with judicious prescribing and regular monitoring of renal function and drug compliance, could help reduce potential complications. </span></span></span></span></p>
Slides
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