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Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)
ConclusionsAll non-vitamin K antagonist oral anticoagulants and warfarin were classified as beneficial or very beneficial in older persons (FORTA-A or -B), underlining the overall positive assessment of the risk/benefit ratio for these drugs. For other vitamin-K antagonists regionally used in Europe, the lack of evidence should challenge current practice.
Source: Drugs and Aging - May 10, 2017 Category: Geriatrics Source Type: research

Thrombolytic Treatment for Ischaemic Stroke: Could the Crisis of Confidence Have Been Avoided by Better Analysis of Trial Data?
AbstractIn many countries, thrombolysis with intravenous alteplase has become a central part of acute stroke care in recent years, requiring radical restructuring of services. However, a significant minority of emergency and stroke physicians have always had serious doubts about the safety and efficacy of thrombolytic treatment, and in 2015 these prompted a major review of the licensing status of alteplase by the UK regulatory authorities. Subsequent dramatic headlines and media stories have called into question the integrity of researchers and clinicians and undermined public faith in medical research. How did this situat...
Source: Drugs and Aging - January 23, 2017 Category: Geriatrics Source Type: research

A Comparison of Oral Anticoagulant Use for Atrial Fibrillation in the Pre- and Post-DOAC Eras
Conclusions There has been an overall increase in OAC use in the NVAF population, attributable to both favorable randomized trial results and aggressive marketing of DOACs in the USA.
Source: Drugs and Aging - May 5, 2016 Category: Geriatrics Source Type: research

Use of Direct-Acting Oral Anticoagulants in Nonagenarians: A Call for More Data
Abstract The prevalence and embolic risk of atrial fibrillation (AF) increase with age. Vitamin K antagonists (VKAs) or direct-acting oral anticoagulants (DOACs) reduce the risk of stroke or embolism. The aim of this review was to summarize the paucity of information regarding the safety and efficacy of DOACs in AF patients aged 90 years or older. The maximum age of included patients is not listed in any of the available DOAC investigating trials and registries, thus it is unclear if nonagenarians were included. Additionally, we could not find any subgroup analysis addressing this issue. There is an urgent need t...
Source: Drugs and Aging - March 31, 2016 Category: Geriatrics Source Type: research

Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke
Conclusions Our results suggest that women, patients aged <75 years, and patients without certain comorbid conditions may need improved assistance in secondary prevention management after an ischaemic stroke.
Source: Drugs and Aging - March 28, 2016 Category: Geriatrics Source Type: research

Quality of Life After Off-Label Thrombolysis for Ischemic Stroke in Elderly Patients
Conclusion QOL after intravenous thrombolysis in the elderly population was comparable to that of younger subjects. Despite its small sample size, this study showed promising results in favor of intravenous thrombolysis in the elderly population and highlighted the importance of systematic screening for post-stroke cognitive impairment, particularly in this population.
Source: Drugs and Aging - October 7, 2015 Category: Geriatrics Source Type: research

Pharmacotherapy to Enhance Cognitive and Motor Recovery Following Stroke
Abstract Stroke is a leading cause of disability among older adults and more than half of stroke survivors have some residual neurological impairment. Traditionally, managing the aftermath of stroke has been by the implementation of several physical and language therapy modalities. The limitations of these rehabilitation efforts have sparked an interest in finding other ways to enhance neurological recovery. Some of these novel approaches have included pharmacological interventions, cell-derived treatments, and cortical magnetic stimulation. Mounting evidence over the last 2 decades suggests that pharmacological ...
Source: Drugs and Aging - September 30, 2015 Category: Geriatrics Source Type: research

Statins for Primary Prevention of Cardiovascular Disease in Elderly Patients: Systematic Review and Meta-Analysis
Conclusions From a risk–benefit perspective, there is a role of statins for the primary prevention of major adverse cardiovascular events in elderly patients. Further studies are needed to ascertain the benefits of statins on fatal MI, stroke and all-cause mortality.
Source: Drugs and Aging - August 6, 2015 Category: Geriatrics Source Type: research

Suicide in Stroke Survivors: Epidemiology and Prevention
Abstract Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for strok...
Source: Drugs and Aging - December 10, 2014 Category: Geriatrics Source Type: research

Secondary Prevention of Stroke in the Elderly: Focus on Drug Therapy
Abstract Secondary stroke prevention in the elderly in many cases requires the use of drug therapy to maximize risk factor control. However, the elderly (≥65 years) are most likely to receive care that is not evidence-based, because of concerns for adverse events. In this review, we provide evidence to the practitioner in support of the value of blood pressure control with drug therapy to decrease recurrent stroke risk. This review also highlights evidence for the importance of statin therapy in stroke prevention among the elderly. Finally, the appropriate use of antiplatelet therapy and oral anticoagulation is addressed.
Source: Drugs and Aging - September 29, 2014 Category: Geriatrics Source Type: research

Cholesterol Treatment Patterns and Cardiovascular Clinical Outcomes Associated with Colesevelam HCl and Ezetimibe
Discussion The evidence of lower risk for composite cardiovascular event rates for subjects treated with colesevelam HCl compared with those treated with ezetimibe suggests the potential need to consider risk of clinical outcomes, in addition to LDL-C levels, in real-world practice when choosing a pharmaceutical treatment.
Source: Drugs and Aging - September 1, 2014 Category: Geriatrics Source Type: research

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