Management of Acenocoumarol in Tunisian elderly population : Risk factors of overdose and bleeding

Abstract

Introduction

Anticoagulant therapy, often required in the elderly, is not without risk. This study aims to investigate the particularities of the use of anticoagulants in the elderly during hospital stay, along with the factors associated with bleeding and overdose.

Results

There were 55 women and 45 men (sex ratio: 0.81), with a mean age of 75.7 ± 6.9 years. The indications for anticoagulant treatment were venous thromboembolism (VTE) (92%) and atrial fibrillation (AF) (8%).

The average duration of treatment with acenocoumarol was 17.22 days ± 7.9. The dose of acenocoumarol initiation was 1 mg in 85% of patients and 2 mg in 15%.

INR < 2 was observed in 15% of patients. INR in the target area was obtained in 47% of patients with a mean dose of 2.33 mg of acenocoumarol. An overdose of acenocoumarol was noted in 38% of patients: average INR at 4.7. Seven patients had bleeding events. An overdose was reported in 4 of them.

Fever, infection, inflammatory syndrome, hypoalbuminemia, hypoprotidemia, and malnutrition were associated with a greater risk of overdose in our patients. Gastroduodenal ulcer disease, past medical history of gastrointestinal bleeding and renal failure were risk factors for bleeding in our patients.

Conclusion

The use of anticoagulants in the elderly requires a comprehensive assessment, including comorbidities, geriatric settings, and social environment.