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In addition to risk of stroke and thromboembolic events in the elderly, there is also the risk of failure to treat. Only approximately 55% of patients with nonvalvular AFib, the majority of nonvalvular AFib patients, actually receive an antithrombin.[124] Since this statistic comes from data that have been collected over the past several decades, this low treatment percentage refers only to treatment with warfarin; however there is no evidence to suggest that physicians are doing a much better job even with the new, novel oral anticoagulant (NOAC) agents that appear to lack the negative treatment challenges posed by warfarin, although in the future with these new agents increasing numbers of patients may receive appropriate antithrombin therapy.
In addition to the low overall use, however, age is again a factor in the failure to treat conundrum. The Figure shows the percentage of patients appropriately receiving warfarin by age group.[124] The principal point, again, is that physicians are not doing a good job with any age group. The second point, however, is that in addition to the younger patients (<55 years) with AFib, it is among the ≥85-year-olds where barely more than 1 in 3 patients with AFib are receiving anticoagulation with warfarin. Thus the rapid in increase in risk with age in AFib represents an opportunity to target special attention to treatment, but so far physicians are not taking advantage of this opportunity as we should.
French WJ. Am J Med 2013; 126: 00-00.
[124] Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Ann Intern Med. 1999;131:927-934.