Deciding on anticoagulating the oldest old with XXXX : insights from cost-effectiveness analysis.

@entity1 @entity64 @entity101 @entity6 @entity63 @entity548 @entity510 @entity955 @entity1229 @entity385
OBJECTIVES: To better understand the tradeoffs between the efficacy of anticoagulation with @entity1229 and its side effects in the oldest old with nonrheumatic @entity955 ( @entity955 ). DESIGN: Cost-effectiveness analysis. SETTING: Published literature, including meta-analyses when available, and web-based sources. @entity1 : Those aged 65 to 100 with @entity955 . INTERVENTION: Anticoagulation with @entity1229 . MEASUREMENTS: Quality-adjusted life expectancy and cost. RESULTS: Anticoagulation is not effective in @entity1 with @entity955 who do not have other risk factors, even in the oldest old. The best argument for its use (prolongation of life at an acceptable cost) can be made in those at major risk for @entity64 because of previous @entity64 or transient @entity63 , @entity6 , and @entity101 , but poor quality of life before anticoagulation and comorbidities that carry their own risks of dying diminish benefits. The decision to anticoagulate the oldest old with @entity955 must take into consideration the risk of @entity64 and of death from @entity64 that existed before anticoagulation, the increased risk of @entity64 and of death from @entity64 while anticoagulated, and the efficacy of anticoagulation. Cost-effectiveness is also influenced by the cost of @entity1229 , the risk of major extracranial @entity548 , the risk (natural and anticoagulated) of death from @entity64 , the rate of @entity385 , the cost of major extracranial @entity548 and @entity64 , the cost of nursing home care, and the fraction of @entity1 with @entity64 who need nursing home care. CONCLUSION: There is no compelling evidence to date that anticoagulation prolongs quality-adjusted life expectancy in the oldest old with nonrheumatic @entity955 . More studies that better estimate the risk of @entity510 with and without anticoagulation in the oldest old are needed before recommendations can be made. The oldest old who are most likely to benefit are those who have a high risk of @entity64 secondary to risk factors other than age alone, although quality of life and life expectancy related to these risk factors limit obtained benefit. Recommendations that all older @entity1 with @entity955 should be anticoagulated are premature.
