Interní Med. 2018; 20(1): 19-23 | DOI: 10.36290/int.2018.005

Anticoagulation therapy in the elderly

doc. MUDr. Jiří Špác, CSc.

2. interní klinika LF MU, Fakultní nemocnice u sv. Anny v Brně

Elderly patients with atrial fibrillation (AF) and venous tromboembolism (VTE) are at elevated risk of thromboembolic events andbleeding compared to younger patients. The most common reason for withholding anticoagulation in older patients is a perceptionof a high risk of falling and associated bleeding, especially intracranial hemorrhage. Assessing the benefit-risk ratio ofanticoagulation is one of the most challenging issues in the individual elderly patient, patients at highest hemorrhagic risk oftenbeing those who would have the greatest benefit from anticoagulants. Some specific considerations are important when usinganticoagulants in the elderly to maximize safety of these treatments, including decreased renal function, co-morbidities and riskof falls, altered pharmacodynamics and concomitant medications. Novel oral anticoagulants (NOACs) have recently emerged asalternatives to Vitamin K Antagonists (VKAs) and could simplify the management and increase the safety of anticoagulaton due tofewer drug/food interactions, rapid onset/offset of action and ease of use, without routine monitoring necessary. Recent studiesand meta-analyses have shown that their efficacy and safety are largely preserved in older patients.

Keywords: anticoagulation therapy, venous tromboembolism, vitamin K antagonists, new peroral anticoagulation drugs

Published: March 1, 2018  Show citation