Heart disease health centre

Warfarin anti-clotting drug may be safe for elderly

1^st September 2011 (Paris) -- The anti-clotting drug warfarin is safe and beneficial for people aged 80 and over, according to a new report. The new research has been welcomed by a UK atrial fibrillation charity which says this older group is often overlooked for anticoagulation  treatment.

Warfarin is being prescribed to around fewer than half of older people with Studies suggest warfarin anticoagulation treatment may be underused for over 80s with atrial fibrillation, a heart condition that results in an irregular heart beat.  This puts them at a higher risk of stroke and so these patients would benefit from warfarin, a second study suggests. The NHS says warfarin should also be taken with caution for elderly people.

The British Heart Foundation says around 800,000 people in the UK have atrial fibrillation and it causes around one in seven first-time strokes.

The Atral Fibrilation Association says 1.2 million people in the UK are prescribed warfarin.

The risk of atrial fibrillation increases with age.

People with AF are more likely to suffer a stroke than people without AF. That's because their erratic heartbeats allow blood to pool and form clots in the heart. The clots can travel to the brain and block blood flow, causing a stroke.

Around one in 10 people over age 80 has AF. That number is likely to increase substantially in the next few years due to the aging of the population, says Dr Daniela Poli, of the Azienda Ospedaliera Universitaria Careggi in Florence, Italy.

"Among people aged 80 to 90, about one quarter of strokes are attributable to atrial fibrillation," she says.

Bleeding risk from warfarin

Studies have shown that warfarin can cut stroke risk by up to 70%, Poli said here at the annual meeting of the European Society of Cardiology.

A known side effect of warfarin is dangerous bleeding, and the risk of warfarin-related bleeding increases with age, Poli tells us. As a result, many doctors are reluctant to prescribe it to older patients, she says.

A second study presented at the meeting shows that only 49% of 213 people with AF over 80 were prescribed warfarin.

"But our study demonstrates a low rate of bleeding complications in older patients, suggesting that age in itself should not be considered a reason to forgo warfarin treatment," Poli says.

Warfarin vs. newer anti-clotting drugs

The findings come at a time when newer warfarin alternatives are being considered by doctors and regulators.

While studies show they may have advantages over warfarin, there is no information on their use in very old people, she says.

Pico presented results of the so-called EPICA Study. It's the largest study on very old patients taking warfarin to prevent stroke or dangerous blood clots.

The study involved 4,093 patients aged 80 to 102 who were being treated with warfarin for the first time. About 60% had moderate kidney damage.