Indications des antivitamines K et de l’aspirine chez les sujets âgés en fibrillation atriale

Abstract: Non valvular atrial fibrillation is a public health concern because of the frequency and the severity of its embolic complications, particularly strokes. The aim of this paper is to analyze the recent recommendations for the prevention of embolic events and their application in the elderly. The recommendations for the prevention of stroke, published in 2001 on the basis of the results of randomized studies comparing vitamin K antagonists (VKA) and aspirin versus placebo, have been modified in August 2006. VKA are recommended in patients at high risk of stroke. In patients considered at moderate risk, the choice is now possible between VKA and aspirin, with a reduced dosage of aspirin (75 to 325mg). The absolute risk of stroke related to age, hypertension, heart failure or diabetes is not yet evaluated. Further studies would be necessary in order to precise the recommendations for patients with only one of these risk factors: aspirin or VKA? In geriatric patients with several risk factors, VKA are under prescribed. A better knowledge of the embolic risk of atrial fibrillation, of the often overestimated hemorrhagic risk of VKA, of the quite underestimated hemorrhagic risk of aspirin and of the recommendations for prevention would be necessary. [Copyright &y& Elsevier]