Palavras-chave
Fibrilação atrial
Idoso
Como Citar
Copyright © | Todos os direitos reservados.
A revista detém os direitos autorais exclusivos de publicação deste artigo nos termos da lei 9610/98.
Reprodução parcial
É livre o uso de partes do texto, figuras e questionário do artigo, sendo obrigatória a citação dos autores e revista.
Reprodução total
É expressamente proibida, devendo ser autorizada pela revista.
Resumo
Objetivo: Sintetizar a efetividade, a segurança e a adesão aos DOACs em idosos com fibrilação atrial na prática real, identificando fatores clínicos como função renal, fragilidade, polifarmácia, risco de quedas e interações, associados a melhores desfechos e ao uso adequado de dose. Métodos: Trata-se de uma revisão integrativa desenvolvida com critérios da estratégia PICO, realizado por meio de pesquisas na base de dados PubMed Central (PMC), Periódico CAPES e Biblioteca Virtual em Saúde (BVS), utilizando os descritores “Atrial Fibrillation”, “Anticoagulants” e “Aged” em combinação com o termo booleano “AND”. Dessa busca, foram encontrados 14.620 e, depois de passados por critérios de inclusão e exclusão, foram selecionados 20 artigos para compor o artigo. Resultados: Os DOACs mostram-se efetivos e seguros em idosos com fibrilação atrial, apresentando maior adesão e menor risco de hemorragia intracraniana em comparação aos AVKs. Fatores como função renal, fragilidade, polifarmácia, risco de quedas e interações influenciam diretamente os desfechos clínicos e a escolha da dose. A individualização do tratamento é essencial para equilibrar eficácia, segurança e adesão na prática real. Considerações finais: Os DOACs são eficazes em idosos com fibrilação atrial, especialmente quando há ajuste individualizado considerando função renal, fragilidade, polifarmácia, risco de quedas e interações medicamentosas.
Referências
AKASHI S, et al. Outcomes and safety of very-low-dose edoxaban in frail patients with atrial fibrillation in the ELDERCARE-AF randomized clinical trial. JAMA network open, 2022; 5(8): e2228500.
CATALANI F, et al. Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study. Internal and emergency medicine, 2023; 18(7): 1941–1949.
CHAMPSI A, et al. Gender and contemporary risk of adverse events in atrial fibrillation. European heart journal, 2024; 45(36): 3707–3717.
DIENER HC, et al. Anticoagulation in patients with device-detected atrial fibrillation with and without a prior stroke or transient ischemic attack: The NOAH-AFNET 6 trial. Journal of the American Heart Association, 2024; 13(17): e036429.
GREWAL K, et al. Bleeding and new malignancy diagnoses after anticoagulation for atrial fibrillation: A population-based cohort study. Circulation, 2025; 151(11): 773–782.
HARRINGTON J, et al. Direct oral anticoagulants versus warfarin across the spectrum of kidney function: Patient-level network meta-analyses from COMBINE AF. Circulation, 2023; 147(23): 1748–1757.
JOHNSON LS, et al. Residual stroke risk among patients with atrial fibrillation prescribed oral anticoagulants: A patient-level meta-analysis from COMBINE AF. Journal of the American Heart Association, 2024; 13(17): e034758.
JOOSTEN LPT, et al. Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation: Results of the FRAIL-AF randomized controlled trial. Circulation, 2024; 149(4): 279–289.
KIM D, et al. Effectiveness and safety of anticoagulation therapy in frail patients with atrial fibrillation. Stroke; a journal of cerebral circulation, 2022; 53(6): 1873–1882.
LUND J, et al. Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study. Open heart, 2021; 8(2): e001737.
NORBY FL, et al. Direct oral anticoagulants and warfarin for atrial fibrillation treatment: Rural and urban trends in Medicare beneficiaries. American journal of cardiovascular drugs: drugs, devices, and other interventions, 2022; 22(2): 207–217.
OLDGREN J, et al. Early versus delayed non-vitamin K antagonist Oral Anticoagulant Therapy after acute ischemic stroke in atrial fibrillation (TIMING): A registry-based randomized controlled noninferiority study. Circulation, 2022; 146(14): 1056–1066.
OUELLET GM, et al. Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia. Journal of the American Geriatrics Society, 2023; 71(2): 561–568.
PILOTTO A, et al. Frailty and anticoagulants in older subjects with atrial fibrillation: the EUROSAF study. Age and ageing, 2023; 52(11).
POLYMERIS AA, et al. Aetiology, secondary prevention strategies and outcomes of ischaemic stroke despite oral anticoagulant therapy in patients with atrial fibrillation. Journal of neurology, neurosurgery, and psychiatry, 2022; 93(6): 588–598.
RITCHIE LA, et al. Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003-2018. Age and ageing, 2022; 51(12).
ROHNER R, et al. Early Versus Late Initiation of Direct Oral Anticoagulants after ischemic stroke in people with atrial fibrillation and hemorrhagic transformation: Prespecified subanalysis of the randomized controlled ELAN trial. Circulation, 2024; 150(1): 19–29.
RUTHERFORD OCW, et al. Effectiveness and safety of oral anticoagulants in elderly patients with atrial fibrillation. Heart (British Cardiac Society), 2022; 108(5): 345–352.
SANGHAI SR, et al. Prevalence of frailty and associations with oral anticoagulant prescribing in atrial fibrillation. Journal of general internal medicine, 2022; 37(4): 730–736.
STUBY J, et al. Oral anticoagulant therapy in older adults. Thrombosis research, 2024; 238: 1–10.
TAHA A, et al. New-onset atrial fibrillation after coronary surgery and stroke risk: a nationwide cohort study. Heart (British Cardiac Society), 2024; 111(1): 18–26.
VELTKAMP R, et al. Direct oral anticoagulants versus no anticoagulation for the prevention of stroke in survivors of intracerebral haemorrhage with atrial fibrillation (PRESTIGE-AF): a multicentre, open-label, randomised, phase 3 trial. Lancet, 2025; 405(10482): 927–936.
VINSON DR, et al. Decision support intervention and anticoagulation for Emergency Department atrial fibrillation: The O’CAFÉ stepped-wedge cluster randomized clinical trial. JAMA network open, 2024; 7(11): e2443097.
WILKINSON C, et al. Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study. Age and ageing, 2021; 50(3): 772–779.
XIA X, et al. Barriers to prescribing oral anticoagulants to inpatients aged 80 years and older with nonvalvular atrial fibrillation: a cross-sectional study. BMC geriatrics, 2022; 22(1): 263.
ZHAO X, et al. Efficacy and safety of anticoagulants in elderly atrial fibrillation patients: a systematic review and network meta-analysis. BMC cardiovascular disorders, 2025; 25(1): 396.