Management of anticoagulation in the elderly requires careful benefit-risk assessment due to competing high thromboembolic and hemorrhagic risks, with new anticoagulants offering potential safety improvements.
Highlights need for tailored anticoagulation in elderly; leaves open optimal NOAC selection pending dedicated trials.
Management of anticoagulation in elderly patients represents a particularly challenging issue. Indeed, this patient population is at high thromboembolic risk, but also at high hemorrhagic risk. Assessment of the benefit-risk balance of anticoagulation is the key point when decisions are made about introducing and/or continuing such treatments in the individual elderly patient. In order to maximise the safety of anticoagulation in the elderly, some specific considerations need to be taken into account, including renal insufficiency, modified pharmacodynamics of anticoagulants, especially vitamin K antagonists, and the presence of multiple comorbidities and concomitant medications. New anticoagulants could greatly simplify and possibly increase the safety of anticoagulation in the elderly in the near future.
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Robert‐Ebadi et al. (2010) studied this question.