7/25/2019 Elderly Patient and Oral Anticoagulation Update

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ELDERLY PATIENT AND ORAL ANTICOAGULATION – THE RISK-BENEFIT

BALANCE

Authors:

Affiliation:1 - Clinical Department of Geriatrics, Hospital for Chronic Diseases "St. Luca "Bucharest,

Romania - !niersit# of $e%icine an% &harmac# "Carol Daila" Bucharest, Romania

Introduction: 'he alue of oral anticoa(ulation therap# in the preention of throm)oem)olic

complications is *ell esta)lishe%. Blee%in( complications in oral anticoa(ulation therap# for ol%

 populations are fre+uent, therefore assessin( the ris of )lee%in( correlate% *ith anticoa(ulationis an important factor in %ecisions re(ar%in( the course of treatment. 

Mt!ri" nd #!t$od%: &atient C. G. #ears ol%, Caucasian, *ith car%io-ascular ris factors

/h#pertension, D0', o)esit# presents in the (eriatric serice for car%ioascular monitorin( an%specialist treatment. 2n terms of (erontolo(ical oerie*, the patient sho*s er# accelerate%

a(in(.3rom preious me%ical histor#: h#pertension /144 'As ma5 6 77 mmH(, fronto-temporal%ementia /%(. in 778, recent trauma of the left le( complicate% *ith left lo*er lim) %eep ein

throm)osis /one month prior to su)mission in the (eriatric clinic at *hich anticoa(ulation

therap# *as initiate% an% renal %ecompensation *hich le% to the patient )ein( a%mitte% in thenephrolo(# clinic /t*o *ees prior to the current presentation.

9n a%mission: malaise, o)esit# /B$2 6 7.;8 ( < m, )e%ri%%en, pale sin an% mucous

mem)ranes, %r# heel )e%sores /left-%e(ree 20, ri(ht-%e(ree 22, left el)o* /%e(ree 22 , sacral

/%e(ree 2, traumatic *oun% of the left anle un%er(oin( healin(, s*ellin( in the arms an% le(s )ilaterall#, h#potonic muscular s#stem, h#potroph#, 'A 6 117<=7 mmH(, tach#car%ia, A0 6 11 <

min, re(ular, *ea pulsatile &e%i arteries /ri(ht> left, a)%ominal a%ipose panicle increase% in

olume, sho*in( %iffuse a)%ominal pain on palpation an% spontaneousl#, lier lo*er e%(e cm )elo* the costal mar(in, normal spleen, *eal# positie )ilateral Gior%ano, mi5e% incontinence,

*ithout chan(es in macroscopic aspect of urine or stool /S!0 fitte% a%mission, temporo-spatial

%isorientation, post-%ementia aphasia. 'he patient *as treate% *ith: Acenocumarolum ; m( %oseof ? t)<%a# of @ 8 %a#s monitore% )# 2R /last 2R 6 1.87, $emantinum 7 m(<%a#,

Riasti(minum patch 1. m(<%a#.

R!%u"t%: La)orator# tests reeale% seere normochromic normoc#tic anemia /H() 6 .; (<%l,

2R 6 1.18 on a%mission, creatinine CL 6 . mL < min CG: sinus rh#thm, A0 6 47 )pm,%iffuse terminal chan(es 'he ris of HAS-BLD )lee%in( 6 .

= %a#s after a%mission, the patient presente% melena. Bein( un%er anticoa(ulant treatment an

upper (astrointestinal )lee%in( is suspecte%, for *hich ice an upper (astrointestinal en%oscop# is performe% to confirm the %ia(nosis: esopha(us *ith normal mucosa an% peristalsis, line to 8

cm of AD, pale mucosa Stomach *ith pale mucosa, er#thema in )an%s at antral leel, p#loric

traction to the rear face Beant p#lorus 2 %uo%enum /)ul) mucosa intensel# con(este% 8< mmappro5 ulcer crater coere% *ith fi)rin an% important perilesional e%ema locate% at the front

face Duo%enum to the si%e *all mucosa con(este% area that is ie*e% *ith %ifficult#

Conclusions: er#thematous antral (astritis, ulcer actie )ul)ar.0ascular Doppler of the left le(: ol% %eep enous throm)osis of the left le(, post-throm)otic

s#n%rome.

7/25/2019 Elderly Patient and Oral Anticoagulation Update

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Gien the %ia(nosis /0', a(e an% me%ical histor# it *as consi%ere% appropriate to continue

anticoa(ulant therap# /for an a%%itional perio% of months *ith clinical reassessment )ut *ith

conersion to ne* (eneration molecules /api5a)an %ue to hi(her safet# profile of re%uce% )lee%in(. After ne* oral anticoa(ulant treatment *as initiate%, iron supplement, (astro-protectie

02 re)alancin( electrol#te an% neuro-re(eneratie, as *ell as continue% antih#pertensie

therap# an% chronic anti%emential treatment the eolution *as faora)le. 'he (eneral con%itionhas improe%, *ith remission of the upper %i(estie hemorra(e, improin( anemia /H() 6 8.4 ( <

%l, after 17 %a#s an% renal function /CrCl 6 8;.41 ml < min *ithout s*ellin( an% sores lesions.

Conc"u%ion%: Gien that antithrom)otic therap# is in constant eolution an% chan(e, on(oin(reie* of recommen%ations for the el%erl#, a (roup of patients *ith hi(h ris of )lee%in(, is

necessar#.

K!&'ord%: oral anticoa(ulants, upper (astrointestinal )lee%in(, throm)osis, el%erl#

&resentation: poster