Anticoagulant Therapy in “Fragile” Elderly Patients: Current State of the Problem

Abstract

The review focuses on the use of oral anticoagulants in fragile elderly patients. The issues of prevalence and diagnosis of senile asthenia syndrome or “fragility”, as well as its effects on the risks of thrombosis, bleeding and death, are discussed. The evidence base, which is quite limited, for the participation of fragile elderly patients in randomized controlled trials and real clinical practice trials with direct oral anticoagulants is presented. Nevertheless, one of the studies of real clinical practice showed that only therapy with rivaroxaban (out of three direct oral anticoagulants) compared with warfarin reduced the risk of stroke/systemic embolism and ischemic stroke alone in fragile elderly patients with atrial fibrillation after 2 years of observation.