Qualité de vie, bénéfices et risques des traitements antagonistes de la vitamine K dans la fibrillation atriale chez les sujets âgés

Abstract : Oral vitamine K antagonits (OAVK) should be used in atrial fibrillation (AF) in older people, but their use is associated with a high risk of bleeding in these patients and they are underused. To increase the adherence to guidelines, the benefit to risk ratio with AVK should be improved in older patients. The assessment of health related quality of life (QOL) may be important to assess benefits and disadvantages of OAVK and to make decisions about treatment. A better health perception could improve the adherence of older patients to anticoagulation. We have shown in a meta-analysis of literature that the use of a minidose or low-dose warfarin treatment (INR<_1,6), as compared with adjusted dose (INR 2-3), did not reduce the risk of bleeding, but did increase the risk of thrombosis. But we were not able in our study to separately analyse the results of the oldest-old. In parallel we tried to determine which QOL instrument should be used to assess QOL in elderly patients, with atrial fibrillation andfor OAVK. We have compared the use of the Duke Health Profile and the MOS SF-36 in older patients and we have compared QOL in AF older patients and controls with these instruments. The SF- 36 is a valid tool in the elderly with perhaps better psychometric properties. But the Duke is a shorter questionnaire, better completed by frailed older people and it seems to be interesting in FA patients in its mental dimension. This work is carried on in further studies with the assessment of QOL questionnaires perhaps better adapted to older people (like the Whoqol-old), or to anticoagulant therapy.
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http://docnum.univ-lorraine.fr/prive/SCD_T_2005_0227_PERRET_GUILLAUME.pdf
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Submitted on : Thursday, March 29, 2018 - 10:49:02 AM
Last modification on : Monday, April 16, 2018 - 10:40:42 AM

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Christine Perret-Guillaume. Qualité de vie, bénéfices et risques des traitements antagonistes de la vitamine K dans la fibrillation atriale chez les sujets âgés. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2005. Français. ⟨NNT : 2005NAN11317⟩. ⟨tel-01746985⟩

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