, Volume 27, Issue 4, pp 461-464
Date: 07 May 2009

Warfarin in vulnerable older adults with atrial fibrillation

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Current indications for anticoagulant therapy in the primary or secondary prevention of thromboembolism span a vast array of clinical syndromes in cardiovascular medicine, from nonvalvular atrial fibrillation (AF) to prosthetic mechanical valves, and the prophylaxis of arterial or venous thrombosis [1, 2]. The complexities of vitamin K antagonist (VKA) administration among patients with AF is heightened substantially in older adults who, in addition to comborbid illness, pose a risk for both thrombotic and hemorrhagic events-either of which can be life-altering or life-threatening.

VKAs, of which warfarin is the most widely used and investigated coumarin derivative, exerts its anticoagulant effects though modulating γ-carboxylation of glutamic acid (GLA) residues of the vitamin K-dependent coagulation factors II, VII, IX, and X, resulting in the production of coagulation factors with reduced coagulant capacity [3]. The estimated disease prevalence of AF is 9% among octogenarians, and gi