Heparins, low-molecular-weight heparins, and pentasaccharides.
Elderly patients require special consideration when administered anticoagulants because of age-related alterations in renal function, protein binding, and increased bleeding risk. Unfractionated heparin can be used in most patients but difficulties with dosing and monitoring often lead to inadequate anticoagulation. Low-molecular-weight heparin has more predictable pharmacokinetics than conventional heparin, but requires dose adjustments in renal impairment and obesity. Fondaparinux is a synthetic pentasaccharide that is being used increasingly for both treatment and prophylaxis of venous thromboembolism. The immune-mediated form of heparin-induced thrombocytopenia is a syndrome with thrombocytopenia or thrombosis in the setting of heparin use. Heparin-induced thrombocytopenia must be identified early, and treated with argatroban or lepirudin to avoid life-threatening complications.
Dinwoodey
Danya L
DL
Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
Ansell
Jack E
JE
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D000077425:Fondaparinux; D015577:Geriatric Assessment; D006207:Half-Life; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008991:Monitoring, Physiologic; D011134:Polysaccharides / Q000009:adverse effects* / Q000627:therapeutic use; D011379:Prognosis; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000517:prevention & control; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux