Am Fam Physician. 2024;109(4):374-375
Author disclosure: No relevant financial relationships.
Key Points for Practice
• Treat older patients who have nonvalvular atrial fibrillation or venous thromboembolism with direct oral anticoagulants, including apixaban and dabigatran, instead of rivaroxaban. Use apixaban in patients with reduced kidney function. Warfarin should be avoided as initial therapy.
• In older adults, sodium-glucose cotransporter-2 inhibitors may be used, but patients should be monitored for urogenital infections and euglycemic diabetic ketoacidosis.
• Avoid combining three or more medications that act on the central nervous system or two or more medications with strong anticholinergic properties.
From the AFP Editors
The Beers criteria for potentially inappropriate medication use in older adults are currently managed by the American Geriatrics Society and have been updated seven times since their introduction in 1991. The criteria suggest medications that should be avoided in most older patients and in certain situations and combinations. These recommendations do not apply to patients in hospice or end-of-life care.
Although medication costs were not factored into risk decisions, the panel understands that costs may be important in shared decision-making.
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