Anticoagulation decisions in elderly patients with stroke - 09/10/20

Doi : 10.1016/j.neurol.2020.04.015

S. Deltour ^a,⁎ , E. Pautas ^b,^c
^a Stroke center, Sorbonne university hospital, Salpêtrière hospital, AP–HP, 47–83, boulevard de l’Hôpital, 75651 Paris cedex 13, France
^b Geriatric unit, Charles-Foix hospital, Sorbonne university hospital, AP–HP, Ivry sur Seine, France
^c Medical school, Paris Sorbonne university, Paris, France

^⁎Corresponding author at: Stroke center, Sorbonne university hospital, Salpêtrière hospital, AP–HP, 47–83, boulevard de l’Hôpital, 75651 Paris cedex 13, France.Stroke center, Sorbonne university hospital, Salpêtrière hospital, AP–HP47–83, boulevard de l’HôpitalParis cedex 1375651France

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Abstract

Primary and secondary prevention of stroke is often a challenge in elderly patients due to the increase in both thrombotic and hemorrhagic risks with age. In some cases, there is sufficient data in the elderly population to allow recommendations or anticoagulation decisions to be made, such as for the indication of anticoagulation to prevent stroke related to atrial fibrillation (AF) or the choice of oral anticoagulant therapy in this situation. In other situations, the less robust data leave some questions; this is the case for the delay to initiate an oral anticoagulant therapy after an AF-related ischemic stroke, for the management of antithrombotic treatment after a stroke of undetermined cause or after intracranial bleeding or in a high-risk bleeding situation associated with stroke in the elderly subject. These issues will be discussed in this paper.

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Keywords : Elderly, Oral anticoagulation, Stroke, Benefit-risk ratio, Hemorrhagic risk