Use of anticoagulants in elderly patients: practical recommendations

Helia Robert-Ebadi, Grégoire Le Gal, Marc RighiniDivision of Angiology and Hemostasis (HRE, MR), Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland, and Department of Internal Medicine and Chest Diseases, EA 3878 (GETBO), Brest Univers...

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Autores principales:	Helia Robert-Ebadi, Grégoire Le Gal, Marc Righini
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2009
Materias:	anticoagulation elderly patients venous thromboembolism hemorrhagic risk atrial fibrillation thrombin inhibitors factor Xa inhibitor Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/2eed0b8b8681471e8d772cac4a0b6aa2
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spelling	oai:doaj.org-article:2eed0b8b8681471e8d772cac4a0b6aa22021-12-02T07:22:54ZUse of anticoagulants in elderly patients: practical recommendations1178-1998https://doaj.org/article/2eed0b8b8681471e8d772cac4a0b6aa22009-04-01T00:00:00Zhttps://www.dovepress.com/use-of-anticoagulants-in-elderly-patients-practical-recommendations-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Helia Robert-Ebadi, Grégoire Le Gal, Marc RighiniDivision of Angiology and Hemostasis (HRE, MR), Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland, and Department of Internal Medicine and Chest Diseases, EA 3878 (GETBO), Brest University Hospital, Brest, France (GLG)Abstract: Elderly people represent a patient population at high thromboembolic risk, but also at high hemorrhagic risk. There is a general tendency among physicians to underuse anticoagulants in the elderly, probably both because of underestimation of thromboembolic risk and overestimation of bleeding risk. The main indications for anticoagulation are venous thromboembolism (VTE) prophylaxis in medical and surgical settings, VTE treatment, atrial fibrillation (AF) and valvular heart disease. Available anticoagulants for VTE prophylaxis and initial treatment of VTE are low molecular weight heparins (LMWH), unfractionated heparin (UFH) or synthetic anti-factor Xa pentasaccharide fondaparinux. For long-term anticoagulation vitamin K antagonists (VKA) are the first choice and only available oral anticoagulants nowadays. Assessing the benefit-risk ratio of anticoagulation is one of the most challenging issues in the individual elderly patient, patients at highest hemorrhagic risk often being those who would have the greatest benefit from anticoagulants. Some specific considerations are of utmost importance when using anticoagulants in the elderly to maximize safety of these treatments, including decreased renal function, co-morbidities and risk of falls, altered pharmacodynamics of anticoagulants especially VKAs, association with antiplatelet agents, patient education. Newer anticoagulants that are currently under study could simplify the management and increase the safety of anticoagulation in the future.Keywords: anticoagulation, elderly patients, venous thromboembolism, hemorrhagic risk, atrial fibrillation, thrombin inhibitors, factor Xa inhibitorHelia Robert-EbadiGrégoire Le GalMarc RighiniDove Medical Pressarticleanticoagulationelderly patientsvenous thromboembolismhemorrhagic riskatrial fibrillationthrombin inhibitorsfactor Xa inhibitorGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 4, Pp 165-177 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticoagulation elderly patients venous thromboembolism hemorrhagic risk atrial fibrillation thrombin inhibitors factor Xa inhibitor Geriatrics RC952-954.6
spellingShingle	anticoagulation elderly patients venous thromboembolism hemorrhagic risk atrial fibrillation thrombin inhibitors factor Xa inhibitor Geriatrics RC952-954.6 Helia Robert-Ebadi Grégoire Le Gal Marc Righini Use of anticoagulants in elderly patients: practical recommendations
description	Helia Robert-Ebadi, Grégoire Le Gal, Marc RighiniDivision of Angiology and Hemostasis (HRE, MR), Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland, and Department of Internal Medicine and Chest Diseases, EA 3878 (GETBO), Brest University Hospital, Brest, France (GLG)Abstract: Elderly people represent a patient population at high thromboembolic risk, but also at high hemorrhagic risk. There is a general tendency among physicians to underuse anticoagulants in the elderly, probably both because of underestimation of thromboembolic risk and overestimation of bleeding risk. The main indications for anticoagulation are venous thromboembolism (VTE) prophylaxis in medical and surgical settings, VTE treatment, atrial fibrillation (AF) and valvular heart disease. Available anticoagulants for VTE prophylaxis and initial treatment of VTE are low molecular weight heparins (LMWH), unfractionated heparin (UFH) or synthetic anti-factor Xa pentasaccharide fondaparinux. For long-term anticoagulation vitamin K antagonists (VKA) are the first choice and only available oral anticoagulants nowadays. Assessing the benefit-risk ratio of anticoagulation is one of the most challenging issues in the individual elderly patient, patients at highest hemorrhagic risk often being those who would have the greatest benefit from anticoagulants. Some specific considerations are of utmost importance when using anticoagulants in the elderly to maximize safety of these treatments, including decreased renal function, co-morbidities and risk of falls, altered pharmacodynamics of anticoagulants especially VKAs, association with antiplatelet agents, patient education. Newer anticoagulants that are currently under study could simplify the management and increase the safety of anticoagulation in the future.Keywords: anticoagulation, elderly patients, venous thromboembolism, hemorrhagic risk, atrial fibrillation, thrombin inhibitors, factor Xa inhibitor
format	article
author	Helia Robert-Ebadi Grégoire Le Gal Marc Righini
author_facet	Helia Robert-Ebadi Grégoire Le Gal Marc Righini
author_sort	Helia Robert-Ebadi
title	Use of anticoagulants in elderly patients: practical recommendations
title_short	Use of anticoagulants in elderly patients: practical recommendations
title_full	Use of anticoagulants in elderly patients: practical recommendations
title_fullStr	Use of anticoagulants in elderly patients: practical recommendations
title_full_unstemmed	Use of anticoagulants in elderly patients: practical recommendations
title_sort	use of anticoagulants in elderly patients: practical recommendations
publisher	Dove Medical Press
publishDate	2009
url	https://doaj.org/article/2eed0b8b8681471e8d772cac4a0b6aa2
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Use of anticoagulants in elderly patients: practical recommendations

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