Residential medication management reviews of antithrombotic therapy in aged care residents with atrial fibrillation: Assessment of stroke and bleeding risk

P. S. Nishtala, R. L. Castelino, G. M. Peterson, P. J. Hannan, M. S. Salahudeen

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

What is known and objective Antithrombotics reduce the risk of stroke in individuals with atrial fibrillation (AF). However, optimal prescribing of antithrombotics in older people remains a challenge. The objective of this study was to assess the risk of stroke for aged care home residents with AF and to examine the pharmacist-led medication reviews on the utilization of antithrombotic therapy. Methods This retrospective study included a random sample of de-identified residential medication management reviews (RMMRs) conducted by accredited pharmacists in aged care homes in Sydney, Australia, between August 2011 and December 2012. The study participants were 146 residents aged 65 years and older with AF living in low- and high-care residential aged care facilities. Antithrombotic therapy was examined among the residents, before and after medication review. CHADS2, CHA2DS2-VASc, and HEMORR2HAGES scoring tools were used to assess the risk of stroke and bleeding and indicate the appropriateness of antithrombotic therapy. Results and discussion The mean age (±SD) of individuals was 88·4 (7·5) years, and 63·7% (n = 93) were female. The majority of residents (n = 99, 67·8%) were aged between 85 and 99 years. The mean (±SD) CHADS2 score was 3·1 (1·1), CHA2DS2-VASc was 4·6 (1·5), and HEMORR2HAGES was 2·3 (1·0). All residents were classified as being at high risk of developing stroke. A total of 115 of 146 (78·8%) residents with AF were prescribed antithrombotics. There was a relatively low usage of anticoagulation (28·1%), and few recommendations from the medication review pharmacists to alter the thromboprophylactic therapy in AF. Application of the CHA2DS2-VASc risk tool indicated that 146 residents were eligible for antithrombotic treatments; of these, 74 (50·7%) were prescribed antiplatelets and 41 (28·1%) were prescribed anticoagulants. Of the 31 (21·2%) residents with AF were not prescribed antithrombotics, 21 (67·7%) had relative contraindications for anticoagulant treatments. What is new and conclusion Although there was a high overall use of antithrombotic agents, the study found a reluctance to prescribe or recommend anticoagulants in eligible older people with AF, potentially due to associated contraindications and multimorbidity. The use of guideline-recommended stroke risk tools could assist medication review pharmacists in optimizing antithrombotic therapy in older adults with AF. The study assessed the risk of stroke for aged care home residents with atrial fibrillation (AF) and examined Residential Medication Management (RMMR) reviews on the utilization of antithrombotic therapy. This study found anticoagulants were underutilized in eligible older people with AF. Guideline-recommended stroke scoring systems, in combination with bleeding risk assessment, may assist RMMR service providers in determining the net clinical benefit of antithrombotic therapy in older adults with AF.

Original languageEnglish
Pages (from-to)279-284
Number of pages6
JournalJournal of Clinical Pharmacy and Therapeutics
Volume41
Issue number3
Early online date7 Apr 2016
DOIs
Publication statusPublished - 1 Jun 2016

Keywords

  • aged care
  • antithrombotic
  • antithrombotic therapy
  • atrial fibrillation
  • drug utilization
  • elderly
  • fibrinolytic agents
  • medication review
  • older people
  • residential care

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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