Consideration of Anticoagulation

Surgical Care for the Elderly in Current Geriatrics Reports

Jared R. Gallaher, Joanna Grudziak, Martin Schreiber

    Research output: Contribution to journalReview article

    Abstract

    Introduction: The geriatric population in the USA is growing at a dramatic rate. As this segment of the population increases in number, surgical providers will increasingly treat and evaluate patients with age-specific needs that affect surgical or trauma management. Consequently, surgeons should be familiar with trends in prescribing oral anticoagulants (OACs), their association with outcomes, and the guidelines for reversing and prescribing these medications. Results: Warfarin was the only oral anticoagulant available in the USA until 2010 when non-vitamin K antagonist oral anticoagulants (NOACs) were introduced to the market. Since then, they have rapidly gained a majority of the US market share. The implications of NOAC use on bleeding complications such as in traumatic brain injury (TBI) are unclear, but evidence suggests that NOACs may be safer than warfarin. Guidelines for anticoagulation reversal in life-threatening bleeding associated with warfarin are well established, but optimal utilization is evolving for most NOAC agents. Conclusion: The use of anticoagulation therapy has changed dramatically over the last decade. These changes are multifactorial and include the increasing prevalence of OAC use, and the introduction of NOACs. Consequently, challenges associated with managing OAC in the elderly will only become more complicated over time. Surgical providers need to be aware of these changes and update their practice on the shifting epidemiology of this population, evolving guidelines, and new reversal agents.

    Original languageEnglish (US)
    JournalCurrent Geriatrics Reports
    DOIs
    StatePublished - Jan 1 2019

    Fingerprint

    Geriatrics
    Anticoagulants
    Warfarin
    Guidelines
    Hemorrhage
    Population
    Epidemiology
    Wounds and Injuries

    Keywords

    • Anticoagulation and surgery
    • Anticoagulation and trauma
    • Elderly anticoagulation
    • Geriatric anticoagulation
    • Oral anticoagulation trends

    ASJC Scopus subject areas

    • Geriatrics and Gerontology

    Cite this

    Consideration of Anticoagulation : Surgical Care for the Elderly in Current Geriatrics Reports. / Gallaher, Jared R.; Grudziak, Joanna; Schreiber, Martin.

    In: Current Geriatrics Reports, 01.01.2019.

    Research output: Contribution to journalReview article

    @article{bf913425db864dd48e17bf7aa780209c,
    title = "Consideration of Anticoagulation: Surgical Care for the Elderly in Current Geriatrics Reports",
    abstract = "Introduction: The geriatric population in the USA is growing at a dramatic rate. As this segment of the population increases in number, surgical providers will increasingly treat and evaluate patients with age-specific needs that affect surgical or trauma management. Consequently, surgeons should be familiar with trends in prescribing oral anticoagulants (OACs), their association with outcomes, and the guidelines for reversing and prescribing these medications. Results: Warfarin was the only oral anticoagulant available in the USA until 2010 when non-vitamin K antagonist oral anticoagulants (NOACs) were introduced to the market. Since then, they have rapidly gained a majority of the US market share. The implications of NOAC use on bleeding complications such as in traumatic brain injury (TBI) are unclear, but evidence suggests that NOACs may be safer than warfarin. Guidelines for anticoagulation reversal in life-threatening bleeding associated with warfarin are well established, but optimal utilization is evolving for most NOAC agents. Conclusion: The use of anticoagulation therapy has changed dramatically over the last decade. These changes are multifactorial and include the increasing prevalence of OAC use, and the introduction of NOACs. Consequently, challenges associated with managing OAC in the elderly will only become more complicated over time. Surgical providers need to be aware of these changes and update their practice on the shifting epidemiology of this population, evolving guidelines, and new reversal agents.",
    keywords = "Anticoagulation and surgery, Anticoagulation and trauma, Elderly anticoagulation, Geriatric anticoagulation, Oral anticoagulation trends",
    author = "Gallaher, {Jared R.} and Joanna Grudziak and Martin Schreiber",
    year = "2019",
    month = "1",
    day = "1",
    doi = "10.1007/s13670-019-00290-w",
    language = "English (US)",
    journal = "Current Geriatrics Reports",
    issn = "1672-6340",
    publisher = "Springer Science + Business Media",

    }

    TY - JOUR

    T1 - Consideration of Anticoagulation

    T2 - Surgical Care for the Elderly in Current Geriatrics Reports

    AU - Gallaher, Jared R.

    AU - Grudziak, Joanna

    AU - Schreiber, Martin

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Introduction: The geriatric population in the USA is growing at a dramatic rate. As this segment of the population increases in number, surgical providers will increasingly treat and evaluate patients with age-specific needs that affect surgical or trauma management. Consequently, surgeons should be familiar with trends in prescribing oral anticoagulants (OACs), their association with outcomes, and the guidelines for reversing and prescribing these medications. Results: Warfarin was the only oral anticoagulant available in the USA until 2010 when non-vitamin K antagonist oral anticoagulants (NOACs) were introduced to the market. Since then, they have rapidly gained a majority of the US market share. The implications of NOAC use on bleeding complications such as in traumatic brain injury (TBI) are unclear, but evidence suggests that NOACs may be safer than warfarin. Guidelines for anticoagulation reversal in life-threatening bleeding associated with warfarin are well established, but optimal utilization is evolving for most NOAC agents. Conclusion: The use of anticoagulation therapy has changed dramatically over the last decade. These changes are multifactorial and include the increasing prevalence of OAC use, and the introduction of NOACs. Consequently, challenges associated with managing OAC in the elderly will only become more complicated over time. Surgical providers need to be aware of these changes and update their practice on the shifting epidemiology of this population, evolving guidelines, and new reversal agents.

    AB - Introduction: The geriatric population in the USA is growing at a dramatic rate. As this segment of the population increases in number, surgical providers will increasingly treat and evaluate patients with age-specific needs that affect surgical or trauma management. Consequently, surgeons should be familiar with trends in prescribing oral anticoagulants (OACs), their association with outcomes, and the guidelines for reversing and prescribing these medications. Results: Warfarin was the only oral anticoagulant available in the USA until 2010 when non-vitamin K antagonist oral anticoagulants (NOACs) were introduced to the market. Since then, they have rapidly gained a majority of the US market share. The implications of NOAC use on bleeding complications such as in traumatic brain injury (TBI) are unclear, but evidence suggests that NOACs may be safer than warfarin. Guidelines for anticoagulation reversal in life-threatening bleeding associated with warfarin are well established, but optimal utilization is evolving for most NOAC agents. Conclusion: The use of anticoagulation therapy has changed dramatically over the last decade. These changes are multifactorial and include the increasing prevalence of OAC use, and the introduction of NOACs. Consequently, challenges associated with managing OAC in the elderly will only become more complicated over time. Surgical providers need to be aware of these changes and update their practice on the shifting epidemiology of this population, evolving guidelines, and new reversal agents.

    KW - Anticoagulation and surgery

    KW - Anticoagulation and trauma

    KW - Elderly anticoagulation

    KW - Geriatric anticoagulation

    KW - Oral anticoagulation trends

    UR - http://www.scopus.com/inward/record.url?scp=85067060794&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85067060794&partnerID=8YFLogxK

    U2 - 10.1007/s13670-019-00290-w

    DO - 10.1007/s13670-019-00290-w

    M3 - Review article

    JO - Current Geriatrics Reports

    JF - Current Geriatrics Reports

    SN - 1672-6340

    ER -