Antithrombotic Therapy Practices in Older Adults Residing in the Long-Term Care Setting
Publication Date
2015
Journal Title
South Med J
Abstract
Objectives To explore physician practice patterns with regard to antithrombotic therapy, including antiplatelets and anticoagulants, in long-term care residents and compare resulting embolic complications. Methods Conducted between August 2012 and March 2013, this study was a retrospective chart review of 400 residents of a long-term care facility. Electronic charts from October 2005 through January 2013 were selected using systematic random sampling. Results Approximately one-third of residents (29.6%) received anticoagulants, 27.3% received antiplatelets, 15.8% received both, and 27.3% did not receive any antithrombotic therapy. The most commonly prescribed antithrombotic drugs were aspirin (37.5%) and warfarin (22.1%). The type of antithrombotic therapy was significantly associated with medical history, including deep vein thrombosis (P = 0.03), the presence of atrial fibrillation (P = 0.001) and other nonsurgical medical conditions (P = 0.0001). Weight (P = 0.009) and body mass index (P = 0.007) also were significantly associated with type of antithrombotic therapy, indicating that heavier residents and those with a higher body mass index were more likely to receive both anticoagulants and antiplatelets. There was no difference in the number of embolic complications among groups. Conclusions Physicians are more disposed to initiate and maintain residents on aspirin while being more cautious when prescribing anticoagulants such as warfarin, dabigatran, heparin, and enoxaparin. In some residents, anticoagulants were not used at all, even when residents had particular risk factors, demonstrating that at times physicians may err on the side of overcautiousness. Antithrombotic therapy should be individualized for each resident based on bleeding risk, comorbidities, and benefits of a particular therapy for our most vulnerable populations.
Volume Number
108
Issue Number
7
Pages
432-436
Document Type
Article
EPub Date
2015/07/21
Status
Faculty
Facility
School of Medicine
Primary Department
Occupational Medicine, Epidemiology and Prevention
Additional Departments
Geriatric and Palliative Medicine; General Internal Medicine; Cardiology
PMID
DOI
10.14423/SMJ.0000000000000312