1. Use of anticoagulants in elderly patients: practical recommendations
- Author
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Helia Robert-Ebadi, Grégoire Le Gal, Marc Philip Righini, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), and Calvez, Ghislaine
- Subjects
Male ,medicine.drug_mechanism_of_action ,MESH: Factor Xa ,Heart Valve Diseases ,Review ,030204 cardiovascular system & hematology ,MESH: Risk Assessment ,Fondaparinux ,Hemorrhagic disorder ,MESH: Venous Thromboembolism ,MESH: Aged, 80 and over ,0302 clinical medicine ,Atrial Fibrillation ,MESH: Renal Insufficiency ,030212 general & internal medicine ,Renal Insufficiency ,anticoagulation ,MESH: Aged ,ddc:616 ,Aged, 80 and over ,hemorrhagic risk ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,valvular heart disease ,Atrial fibrillation ,General Medicine ,Heparin ,MESH: Accidental Falls ,3. Good health ,MESH: Atrial Fibrillation ,thrombin inhibitors ,Factor Xa ,Female ,Risk assessment ,medicine.drug ,medicine.medical_specialty ,Heart Valve Diseases/drug therapy ,Factor Xa Inhibitor ,venous thromboembolism ,MESH: Anticoagulants ,elderly patients ,Hemorrhagic Disorders ,Risk Assessment ,03 medical and health sciences ,medicine ,Anticoagulants/pharmacokinetics/pharmacology/therapeutic use ,Humans ,cardiovascular diseases ,Intensive care medicine ,Aged ,MESH: Humans ,business.industry ,Atrial Fibrillation/drug therapy ,Renal Insufficiency/chemically induced ,factor Xa inhibitor ,RC952-954.6 ,Anticoagulants ,MESH: Heart Valve Diseases ,medicine.disease ,Venous Thromboembolism/prevention & control ,Hemorrhagic Disorders/etiology ,MESH: Male ,Geriatrics ,Accidental Falls ,Geriatrics and Gerontology ,business ,MESH: Female ,MESH: Hemorrhagic Disorders ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Discovery and development of direct thrombin inhibitors - Abstract
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
- Published
- 2009