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All Journal Jurnal Farmasi Klinik Indonesia Journal of Islamic Pharmacy JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Jurnal SOLMA Pharmaceutical Journal of Indonesia Hubungan Tingkat Pengetahuan Petugas Pengelola Obat dengan Tingkat Ketersediaan Obat Di Puskesmas Kota Malang J.Abdimas: Community Health Pharmaceutical And Biomedical Sciences Journal (PBSJ) Society: Jurnal Pengabdian Masyarakat Jurnal Pengabdian Masyarakat Bangsa Jurnal Pengabdian Farmasi dan Sains
Wiyati, Tuti
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Safety Profile of Oral Anticoagulants in Elderly Atrial Fibrillation Patients: A Review Focused on Bleeding Risk in Secondary Stroke Prevention Viviandhari, Daniek; Wiyati, Tuti
Pharmaceutical Journal of Indonesia Vol. 10 No. 2 (2025)
Publisher : Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

The elderly population has the highest risks of bleeding due to oral anticoagulant use to prevent secondary stroke since causes higher levels of anticoagulant status fluctuation. However, the detailed information on safety issues regarding bleeding effect of oral anticoagulant from elderly population perspective with atrial fibrillation is still lacking. This narrative review was conducted to summarize the study findings from the present literature. This review was conducted using PubMed and Scopus database. Data were retrieved from 2017 until 2023. Articles were considered for inclusion if they discussed the safety of oral anticoagulant for secondary stroke prevention in Atrial Fibrillation (AF) patients. A total of 9 articles were extracted. The design of the studies, participant characteristics, and the risk of bleeding events were all assessed. The Hazard Ratio (HR) ranged from 2.82 to 0.58 across 5 trials. There were three occurrences of significant hemorrhage with delayed Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) and seven cases with early NOACs. When comparing acute reperfusion to no reperfusion, the Odd Ratio (OR) of 1 study was 0.74. One study found that the incidence of significant bleeding was 2.1% in the case of standard warfarin use and 0% in the case of early apixaban use. Research comparing warfarin and rivaroxaban in patients with mild AF found a Relative Risk (RR) of 0.91. NOACs/Direct Oral Anticoagulants (DOACs) are relatively safe to use, while International Normalized Ratio (INR)-guided Vitamin K antagonists (VKAs) should be use with cautions in the elderly with AF for secondary stroke prevention concerning bleeding events, regardless of independence status (patient’s level of functional independence), presence of acute reperfusion treatment, Embolic Stroke of Undetermined Source (ESUS), Patent Foramen Ovale (PFO), and decreased renal function.
Co-Authors Apriliyanti, Netha Apriliyanti Bahiah, Faridatul Fatmawati, Sofia Guri, Amelia Zaida Hastuti, Septianita Lestari, Puja Maifitrianti Maifitrianti, Maifitrianti Mediyantei, Zelin Nabilla, Adistya Risma Ni Putu Ermi Hikmawanti Nugrahaeni, Fitria Numlil Khaira Rusdi, Numlil Khaira Nur Hasanah Nurhasna, Nurhasna Pahriani, Ani Pahriyani, Ani Rahayu, Yayuk Vivi Anggia, Vivi Viviandhari, Daniek Wulandari, Nora Zaid, Liesca Tria Novalita