Thromboembolic disease: a geriatric syndrome

The incidence of thrombotic cardiovascular disease increases with age. Several potential reasons can explain the association between thrombosis risk and age, such as the high prevalence of predisposing illnesses among older people and age-related changes in hemostasis pathways, including endothelial dysfunction, alterations in platelet function, coagulation and fibrinolytic factors, that contribute to create a hypercoagulability of the blood. Furthermore, some components of this procoagulant status may also support the inflammatory processes that characterize advancing age, promoting an increased risk of a thrombo-inflammatory disease. However, despite the increased thrombotic risk make the older patient a theoretical target for anticoagulant therapy, the concomitant risk of major bleeding make the use of this drugs problematic, with consequent underuse. This review summarizes the physiological changes of hemostasis pathways in older people in the context of thromboembolic disease as a geriatric syndrome. The balance between thrombotic and hemorrhagic risk and therefore the therapeutic efficacy of anticoagulant medications are also discussed.