Even though these formulas have not been specifically validated in large populations of geriatric patients, they provide a better estimation of renal function than the serum creatinine level, and thus are commonly used in almost all age groups in clinical practice. some point, either on a short or a long term basis. The most frequently encountered indications for anticoagulation in this category of patients are atrial fibrillation (AF), with a prevalence of approximately 10% in patients over 80 years of age [1], and the prevention and Paclitaxel (Taxol) treatment of venous thromboembolism (VTE). Indeed, the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) increases almost exponentially with age, and the majority of all VTE events occur in patients over 70 years of age [2]. In this article, we first review the different indications for anticoagulation treatments, which are basically the same as in other age groups. Then, specific considerations to bear in mind when prescribing anticoagulants in the elderly are discussed, as well as their implication for each category of anticoagulants. Finally, some future perspectives provided by new anticoagulants are offered. == 2. General Indications for Anticoagulation == Even though prevalence of medical conditions transporting a thromboembolic risk is Paclitaxel (Taxol) usually higher in older than in more youthful patients, the actual indications for anticoagulation are basically the same in all age groups and you will find no data specifically focused on the elderly. Four major clinical situations warrant introduction of anticoagulant therapy: VTE prophylaxis, VTE treatment, AF and valvular heart disease. However, when stratifying the risk of thromboembolism in these different clinical settings, older age is usually often independently associated with a higher risk. == FLICE 2.1. Venous Thromboembolism (VTE) Prophylaxis == There is an overall tendency to under-use prophylactic anticoagulation in elderly medical inpatients, which seems to be more based on the physicians fear of higher bleeding risk than on objective data [3,4]. Among elderly medical inpatients, older age (75 years) is known to be an independent risk factor for VTE with an odds ratio of 1 1.5 for every 10 years of increase in age [5]. In a study on 852 elderly patients in subacute medical models, DVT prevalence was 15.8% with systematic reduce limb ultrasound, and prevalence ofproximalDVT was of 5.9%, in spite of a 56.1% rate of prophylactic anticoagulant therapy [6]. Assessing the need for VTE prophylaxis seems therefore even more important in older than in more youthful medical inpatients. Overall, the benefits of VTE prophylaxis in elderly inpatients often outweigh its risks, provided some basic precautions are observed. In surgical patients, VTE risk seems to be more related to the type of surgery than to age [7]. The latest Evidence-Based Clinical Practice Guidelines of the American College of Chest Physicians (ACCP) published in 2008 for VTE prophylaxis in hospitalized patients suggest the use of low molecular excess weight heparins (LMWH), unfractionated heparin (UFH) or fondaparinux for all those patients apart from those considered at low risk for VTE (<10% without thromboprophylaxis), represented by cases of minor medical procedures in mobile patients and medical patients who are fully mobile [8]. One can very easily Paclitaxel (Taxol) infer that elderly patients are less likely to fall into this latter subgroup of low risk patients. == 2.2. Venous Thromboembolism (VTE) Treatment == Unless there is an complete contraindication, anticoagulation at therapeutic doses should be initiated as soon as the diagnosis of DVT or PE is usually objectively confirmed, as well as in patients with a high probability of DVT or PE while awaiting the outcome of further diagnostic assessments. This initial phase of treatment consists of subcutaneous LMWH, subcutaneous fondaparinux, or intravenous/subcutaneous UFH with a grade 1A level of recommendation for all these substances in the latest Evidence-Based Clinical Practice Guidelines of the ACCP. The initial treatment is then overlapped and followed by a vitamin K antagonist (VKA) [9]. The average age of patients population being usually much lower in clinical trials of antithrombotic therapy in VTE than Paclitaxel (Taxol) in AF, one might be reluctant to directly extrapolate the results of VTE trials to elderly patients, especially because of a fear of bleeding effects. However, if fatal outcomes are considered, even nonagerians presenting with acute PE benefit from anticoagulation, as the incidence of fatal PE is usually by far.
Even though these formulas have not been specifically validated in large populations of geriatric patients, they provide a better estimation of renal function than the serum creatinine level, and thus are commonly used in almost all age groups in clinical practice
