Pharmaceutical intervention after evaluation of the risk of ictus in elderly patients institutionalized with atrial fibrillation

OBJECTIVES: To evaluate the risk of having a stroke and the risk of bleeding in institutionalized patients with atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia associated with increased morbidity and mortality. It is necessary to develop pharmacotherapy plans to minimize the risk. DESIGN: A prospective study. SETTING: Institutionalized patients. PARTICIPANTS: Inclusion criteria were: patients diagnosed with atrial fibrillation, with or without treatment for the prevention of stroke. MAIN OUTCOME MEASURES: The evaluation of the CHA2DS2-VASc criteria was performed. The risk of hemorrhage was assessed using the HAS-BLED scale, based on the risk factors associated with the probability of bleeding. RESULTS: We included 53 patients (86.4 ± 6.4 years, 30.2% men). Of these, 37 (69.8%) were correctly anticoagulated. Of the remaining, 5 patients (31.2%) did not have any type of anticoagulant or antiaggregant treatment and 11 (68.7%) were treated with antiaggregant alone. The pharmaceutical intervention was performed in patients who did not meet stroke criteria. Of the untreated patients: two died before the intervention, two were recommended to be referred to cardiology and in one there was no intervention because of very advanced age. In the antiaggregant patients, it was decided not to modify the treatment. The reasons were: high risk of bleeding, very advanced age, advanced dementia or terminal illness, moderate risk of stroke, and clotting factor deficiency. CONCLUSIONS: The risk of stroke in elderly patients with atrial fibrillation is high, so it is important to control the risk factors.