Key result
Oral anticoagulation therapy in elderly patients requires careful assessment of the relative risks of recurrent thromboembolism and major bleeding to guide treatment decisions.
This review summarizes the pharmacology, drug interactions, and dosing recommendations of warfarin to help clinicians balance the risks of thromboembolism and major bleeding in elderly patients.
Highlights ongoing challenges balancing thrombosis and bleeding risks in elderly patients; leaves open the role of direct oral anticoagulants.
Oral anticoagulation therapy has demonstrated benefit in the treatment and prevention of a variety of thromboembolic disorders. Most individuals who receive oral anticoagulant therapy are elderly patients with nonvalvular atrial fibrillation and acute or recurrent venous thromboembolism. Anticoagulation in elderly patients poses unique challenges for the practicing clinician because they are simultaneously at higher risk for recurrent thromboembolism and major bleeding, including catastrophic intracranial hemorrhage. The pharmacology of warfarin in the elderly is reviewed, including important drug interactions and current dosing recommendations for elderly patients. Evidence of the benefits and risks of oral anticoagulation therapy are reviewed for patients with atrial fibrillation and venous thromboembolism. This information should enable practitioners to better assess the relative risks and benefit of oral anticoagulation therapy to guide treatment decisions in the elderly.
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Henderson et al. (2001) conducted a review in Atrial fibrillation and venous thromboembolism. Oral anticoagulation therapy (warfarin) was evaluated. Oral anticoagulation therapy in elderly patients requires careful assessment of the relative risks of recurrent thromboembolism and major bleeding to guide treatment decisions.
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