Hospitalisierte geriatrische Patienten mit Vorhofflimmern sind nicht ausreichend mit Antikoagulanzien behandelt

 

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Zusammenfassung

Hintergrund und Fragestellung | Die (orale) Antikoagulation ist zur Prävention kardioembolischer Ereignisse hocheffektiv, wird aber bei gebrechlichen, älteren Patienten mit Vorhofflimmern oder -flattern (VHF) oft nicht angewandt. Das Ziel dieser Studie war es, zu untersuchen, ob die Antikoagulationstherapie (AKT) bei Patienten mit VHF Leitlinien-gerecht umgesetzt wird und welche Komplikationen bei geriatrischen Patienten vorkommen.

Methodik | Retrospektiv wurden die Patienten des Geriatrischen Zentrums des Ev. Krankenhaus Göttingen-Weende auf ein VHF und die Verordnung der AKT im Verlauf eines Jahres untersucht. Das Schlaganfallrisiko der untersuchten Patienten mit VHF und die Indikation für eine dauerhafte AKT wurde anhand des CHA₂DS₂-VASc-Scores bestimmt.

Ergebnisse | Von 1167 stationär oder teilstationär behandelten Patienten bestand bei 451 Patienten (38,6 %) eine eindeutige Indikation für eine dauerhafte AKT. Die häufigste Indikation war VHF (381 Patienten, 84,5 %). Von diesen 381 Patienten bestand anhand CHA₂DS₂-VASc-Scores eine eindeutige Indikation für eine AKT bei 379 Patienten, von denen 200 (52,8 %) antikoaguliert wurden und 179 (47,2 %) Patienten keine AKT erhielten. Thrombozytenaggregationshemmer (TAH) erhielten 153 Patienten (40,4 %). 26 Patienten (6,7 %) erhielten weder eine AKT noch eine Therapie mit einem TAH.

Der häufigste Grund für die Nicht-Umsetzung der Leitlinie war eine erhöhte Sturzgefahr bei 93 Patienten (52 %) von 179 Patienten ohne Antikoagulation. Als häufigste Komplikationen fand man kleine Blutungen ohne schwerwiegende Folgen in 8 Fällen. Schwerwiegende Blutungen erlitten 4 Patienten.

Folgerung | Fast die Hälfte unserer geriatrischen Patienten erhielt keine AKT trotz klarer Indikation. Die Gabe von TAH war mit dem Nichtgebrauch der AKT assoziiert.

Abstract

Introduction: Anticoagulation for the prevention of cardioembolic events is highly effective, but largely underused in frail older patients with atrial fibrillation or flutter (AF). This study aimed at identifying characteristics associated with anticoagulation use or non-use and the most frequent complications of this therapy.

Methods: Hospitalized geriatric patients treated in a one-year interval were retrospectively studied for the presence of AF and use or non-use of anticoagulation. The risk of stroke and the indication for permanent anticoagulation were assessed using the CHA₂DS₂-VASc score.

Results: In 451 of 1167 hospitalized patients (38.6 %) there was a clear indication for anticoagulation. The most frequent indication for anticoagulation was AF in 381 patients (84.5 % of 451 patients). Of these 381 patients, a strong indication for anticoagulation, based on CHA₂DS₂-VASc score, was identified in 379 patients. Of these patients, 200 (52.8 %) did and 179 (47.2 %) patients did not receive anticoagulation. 153 patients (40.4 %) received antiplatelet therapy. 26 patients (6.7 %) received neither anticoagulants nor antiplatelet therapy. The most common reason for non-implementation of anticoagulation was a high risk of falls in 93 patients (52 %) of 179 patients without antocoagulation. The most frequent complications of anticoagulation were small hemorrhages without serious consequences in 8 cases. 4 patients suffered from serious bleedings.

Conclusion: Almost half of our geriatric population did not receive anticoagulation despite a clear indication. Antiplatelet therapy use was associated with anticoagulation non-use.

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