Treatment of deep venous thrombosis and pulmonary embolism with low molecular weight heparin in the geriatric patient population.
Low-molecular-weight heparins have provided a new approach to treating DVT-PE. These anticoagulants have better bioavailability, a longer half-life, and a more predictable antithrombotic effect than UFH. In the studies reviewed, LMWHs were shown to be safe and effective in preventing recurrent thrombotic events when compared with the more precise UFH dosing schedules. There has been no evidence of an increased incidence of major bleeding or recurrent thromboembolic events based on age in these trials. With these findings LMWHs given subcutaneously, without laboratory monitoring, in a dose determined by actual body weight allows clinicians involved in the care of the elderly to manage these patients with DVT with or without PE in the nursing home setting, skilled nursing care facilities, rehabilitation units, acute care hospital setting, or as described in this article at home. These patients can continue their physical therapy programs because intravenous infusion lines and the necessity to be maintained at bedrest do not encumber them.
Division of Internal Medicine and Primary Care, Department of Medicine, Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Geno.Merli@mail.tju.edu
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D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011379:Prognosis; D011655:Pulmonary Embolism / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight