Haemostasis and Transfusion. Perioperative Management in Elderly Patients (Graz, Austria, October 27–28, 2000)

With the proportion of older adults in the population of Western countries continuing to grow, the number of geriatric surgical patients has increased dramatically. Anemia is very frequently found in these patients, because of their higher incidence of comorbidity and because of the often necessary surgery. Although low hematocrit levels appear, surprisingly, to be well tolerated in the perioperative period, they are, in fact, a significant risk factor for morbidity and mortality, particularly in the postoperative period as well as in normal daily life. The simple transfusion of erythrocytes only partly reduces these risks, if at all; in some cases the risks are even increased. We therefore need to develop effective, patient-friendly, and economically defensible strategies to reduce the perioperative risk of anaemia. Furthermore, it is not clear what the prognostic significance of age-related coagulation disorders is. Because of the danger of cardiovascular complications and thromboembolism, older patients as a rule receive antithrombotic agents, which can make perioperative coagulation management more difficult, increase perioperative blood loss and thereby heighten the risk of anemia. To facilitate making acute diagnoseswhich are so important in the perioperative period -, several new methods specifically for testing at 'point of care' are being investigated or are already part of clinical routine.