People aged ninety and over can safely take blood thinners. This is the conclusion of doctor of internal medicine in training Hilde Kooistra and Professor of Coagulation Disorders at the UMCG Karina Meijer. It is based on PhD research conducted by Kooistra in the UMCG, which was published in this week’s JAMA Internal Medicine. ‘This means that we will be able to prevent more strokesin older adults.’
Blood thinners are often prescribed to the over-seventy-fives to prevent clots from forming in their blood (thrombosis). Clots tend to develop in the heart of patients with atrial fibrillation, for example. If these clots reach the brain, they can cause a stroke. Stroke can lead to disability and diminished quality of life, particularly in elderly patients.
One of the drawbacks of blood thinners is that they increase the risk of bleeding, which can also have serious implications. Current thinking is that blood thinners prescribed to the over-seventies prevent more cases of thrombosis than they cause bleeding. However, doctors are more cautious about prescribing them to patients in their nineties because it is thought that the risk of bleeding increases with age.
The thrombosis service regularly checks the blood and physical condition of elderly people taking vitamin K antagonist, a type of blood thinners. For her research, Kooistra was given access to their data. ‘We compared data from around 1,100 patients in their nineties who were taking blood thinners with those of patients in their seventies and eighties. There was no difference in the incidence of bleeding between the patients in their seventies and those in their eighties. However, although the incidence of bleeding among patients in their nineties rose, the rise was not as large as previously assumed. The research shows that blood thinners are usually just as safe for patients in their nineties as they are for patients in their seventies or eighties. The risk of thrombosis is much higher than the risk of bleeding, so the advantages of the drugs outweigh the disadvantages.’
‘This research clearly shows that age should not be an issue when prescribing blood thinners’, concludes Meijer. ‘We can use the same guidelines for all elderly patients. Doctors should focus on the health of the individual instead of his or her age.’ This would mean that more ninety-year-olds could be prescribed blood thinners than is currently the case. ‘ The incidence of bleeding would not increase dramatically, but it would help to prevent stroke. ’
Read the article in Jama here: http://archinte.jamanetwork.com/article.aspx?articleid=2530903
A PhD dissertation consisting of more than 1100 pages and covering a total of 31 chapters. UMCG PhD-candidate Arno Bourgonje (26) probably wrote the most voluminous medical PhD dissertation ever published in the Netherlands.
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