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

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Abstract

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 (ORprosthetic 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 (ORfluindione 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.

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Acknowledgments

I, Professor Olivier Hanon, corresponding author, hereby affirm that I have listed everyone who contributed significantly to the work and have obtained written consent from all contributors who are not authors and are named in the Appendix in the Electronic Supplementary Material.

The present study was supported by the French Society of Geriatrics and Gerontology (Société Française de Gériatrie et Gérontologie—SFGG).

Conflicts of interest

Gilles Berrut reports consulting and/or lecture fees from Boehringer Ingelheim, Sanofi-Aventis, Bayer-Schering Pharma, and Novartis.

Nathalie Maubourguet reports consulting and/or lecture fees from Novartis, Eisai, and Lundbeck.

Claude Jeandel reports consulting and/or lecture fees from Boehringer Ingelheim.

Olivier Hanon reports consulting and/or lecture fees from Boehringer Ingelheim, Sanofi-Aventis, Daichi-Sankyo, Bayer-Schering Pharma, Bristol-Myers Squibb, Servier, Abbott, and Novartis.

All the other authors have no conflicts to report.

Authorship contributions

Conception and design: Gilles Berrut, Nathalie Maubourguet, Claude Jeandel, Jean-Paul Emeriau, Joel Ankri, Hélène Bouvier, Geneviève Ruault, Olivier Hanon.

Acquisition of data: Matthieu Plichart, Gilles Berrut, Nathalie Maubourguet, Claude Jeandel, Jean-Paul Emeriau, Joel Ankri, Hélène Bouvier, Geneviève Ruault, Olivier Hanon.

Analysis and interpretation of data, drafting of the manuscript: Matthieu Plichart.

Critical revision of the manuscript for important intellectual content: Gilles Berrut, Nathalie Maubourguet, Claude Jeandel, Jean-Paul Emeriau, Joel Ankri, Hélène Bouvier, Geneviève Ruault, Olivier Hanon.

Drafting of the manuscript, supervision, full access to all the data, and responsibility for the integrity of the data and the accuracy of the data analysis: Olivier Hanon.

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Authors and Affiliations

  1. French Society of Geriatrics and Gerontology, Suresnes, France

    Matthieu Plichart, Gilles Berrut, Nathalie Maubourguet, Claude Jeandel, Jean-Paul Emeriau, Joël Ankri, Hélène Bouvier, Geneviève Ruault & Olivier Hanon

  2. Broca Hospital, Assistance Publique—Hôpitaux de Paris, 54-56 rue Pascal, 75013, Paris, France

    Matthieu Plichart & Olivier Hanon

  3. EA 4468, University Paris Descartes, Sorbonne Paris Cité, 54-56 rue Pascal, 75013, Paris, France

    Matthieu Plichart & Olivier Hanon

  4. Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France

    Matthieu Plichart

  5. Department of Geriatrics, Nantes University Hospital, Nantes, France

    Gilles Berrut

  6. EHPAD La Renaissance, Pessac, France

    Nathalie Maubourguet

  7. Gerontology Centre Antonin Balmes, University Hospital, University I, Montpellier, France

    Claude Jeandel

  8. Pôle de gérontologie clinique, Bordeaux University Hospital, Xavier-Arnozan Hospital, Pessac, France

    Jean-Paul Emeriau

  9. Santé Vieillissement Research Group, Versailles St Quentin University, Paris, France

    Joël Ankri

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  1. Matthieu Plichart
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  2. Gilles Berrut
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  4. Claude Jeandel
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  8. Geneviève Ruault
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  9. Olivier Hanon
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Corresponding authors

Correspondence to Matthieu Plichart or Olivier Hanon.

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Plichart, M., Berrut, G., Maubourguet, N. et al. Use of Vitamin K Antagonist Therapy in Geriatrics: A French National Survey from the French Society of Geriatrics and Gerontology (SFGG). Drugs Aging 30, 1019–1028 (2013). https://doi.org/10.1007/s40266-013-0127-3

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