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Original

Oral anticoagulant prescribing in elderly patients above and below age 80 with atrial fibrillation 

Kun Xie, Jun Shen, Nanqing Xiong, Jian Li, Huanchun Ni, Fei Yuan, Jinjin Zhang, Hua Chen, Wen Gao, Xiaofei Jiang, and Xinping Luo

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Volume 57 (2019) p. 458 - 463

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 57 – No. 9/2019 (458-463)

Oral anticoagulant prescribing in elderly patients above and below age 80 with atrial fibrillation 

Kun Xie, Jun Shen, Nanqing Xiong, Jian Li, Huanchun Ni, Fei Yuan, Jinjin Zhang, Hua Chen, Wen Gao, Xiaofei Jiang, and Xinping Luo

Cardiology Department, Huashan Hospital, Fudan University, Shanghai, China
Background: Oral anticoagulation is efficient to prevent ischemic stroke in atrial fibrillation (AF), but in very old patients, physicians always remain cautious to use anticoagulants concerning the bleeding risk. This research aims to investigate the current situation of oral anticoagulation therapy in very old (≥ 80 years) AF patients. Materials and methods: We carried out a cross-sectional study in an urban area in China from 2014 to 2016. Characteristics of the very old patients (age ≥ 80 years) and the younger patients (age < 80 years) were compared. Logistic analysis was used to estimate the association between oral anticoagulation therapy and CHA₂DS₂-VASc score. Results: A total of 1,000 AF patients were enrolled; 306 were very old patients, and 694 were younger patients. In the very old group, 48.0% were women, and the average age was 84.12 ± 3.62 years. In the younger group, 35.3% were women, and the average age was 66.92 ± 9.02 years. CHA₂DS₂-VASc score was 2.8 ± 1.7 in the younger group and 4.5 ± 1.5 in the very old group (p < 0.001). The proportion of oral anticoagulation was low in patients with AF (31.8%) and even lower in very old patients compared to younger patients (24.5 vs. 35.0%, p = 0.004). Moreover, oral anticoagulation therapy was strongly associated with CHA₂DS₂-VASc scores only in the younger group, but not in the very old group, which means the very old patients were not treated with oral anticoagulation according to their elevated CHA₂DS₂-VASc scores. Conclusion: Anticoagulants were underused in AF patients, particularly in very old patients. Evidence is accumulating that the very old patients could still benefit from anticoagulants so that physicians should not exclude such patients from anticoagulation only because of their older age.Correspondence to:
 Xiaofei Jiang, MD PhD
Cardiology Department, Huashan Hospital, Fudan University
12 Mid Wulumuqi Road, Shanghai, 200040, China
Email: cardiologyhs@ hotmail.com

Original

Network meta-analysis of bisphosphonates in the treatment of bone metastases from breast cancer 

Li-Wen Zhang, An Huang, Hong-Fang Ma, and Jun Shen

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Volume 64 (2026) p. 470 - 481

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 9/2026 (470-481)

Network meta-analysis of bisphosphonates in the treatment of bone metastases from breast cancer 

Li-Wen Zhang¹*, An Huang²*, Hong-Fang Ma³, and Jun Shen¹

¹Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, ²Department of Breast Surgery, Maternal and Child Health Hospital, Yiwu City, and ³Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
Objective: Through a network meta-analysis, this study aimed to systematically evaluate the efficacy and safety of bisphosphonates in reducing skeletal-related events in patients with bone metastases from breast cancer, providing clinical guidance for treatment selection.
Materials and methods: Randomized controlled trials (RCTs) on bisphosphonate therapy for bone metastases in breast cancer were retrieved from PubMed, Cochrane, and Embase databases from inception to January 2025. Statistical analyses were performed using Stata software.
Results: 22 studies involving 14,934 patients were included. The bisphosphonates evaluated were pamidronate, zoledronate, clodronate, and ibandronate. Regarding the reduction of pathological fractures, the efficacy ranking was clodronate > ibandronate > pamidronate > zoledronate. Significant differences were found between clodronate and pamidronate (OR = –1.41, 95% CI: –2.78 to –0.04) and between clodronate and zoledronate (OR = –1.44, 95% CI: –2.85 to –0.04). For hypercalcemia reduction, zoledronate was more effective than clodronate and pamidronate, though differences were not statistically significant (p > 0.05). In terms of safety, ibandronate showed fewer adverse reactions than clodronate and zoledronate, with a significant difference between ibandronate and zoledronate (OR = –1.14, 95% CI: –1.99 to –0.28).
Conclusion: Clodronate was most effective in reducing pathological fractures, zoledronate was superior in controlling hypercalcemia, and ibandronate demonstrated the best safety profile. Further clinical studies are warranted to clarify the comparative advantages of each bisphosphonate and support individualized treatment decisions.

*Both authors contributed equally to this study.Correspondence to:
Jun Shen, MD
Department of Surgical Oncology
Sir Run Run Shaw Hospital
Zhejiang University School of Medicine
No. 3. East road of Qingchun
Hangzhou 310016, Zhejiang Province, China
Email: [email protected]

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