title: A need for evidence-based clinical practice guidelines for the use of heparins in the elderly.
abstract: Low-molecular-weight heparins (LMWHs) have been widely studied in pivotal clinical trials or in several meta-analyses. However, the safety and optimal use of LMWHs in high-risk patients such as the very elderly remains uncertain since these patients are usually excluded from clinical trials. In terms of LMWHs in the elderly, the main concerns are renal failure and the risk of accumulation. A clinical approach consisting of a LMWH dose reduction in the elderly should be considered with great caution in terms of efficacy, since it has been tested neither in the treatment of VTE nor in VTE prophylaxis. If monitoring is considered in patients receiving therapeutic dose LMWHs, appropriate target ranges for peak anti-Xa activity levels should be used and so far, no anti-Xa activity-based guidelines have been issued. Moreover, no data support any laboratory monitoring in elderly patients treated with prophylactic dose LMWHs.
authors.affiliation: Assistance Publique Hôpitaux de Paris, Laboratoire d'Hématologie, Hôpital Charles Foix, and Université Paris Descartes, INSERM U, Paris, France. isabelle.gouin@cfx.aphp.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gouin-Thibault
authors.forename: Virginie
authors.initials: V
authors.lastname: Siguret
authors.forename: Eric
authors.initials: E
authors.lastname: Pautas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D015951:Factor Xa / Q000187:drug effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency / Q000139:chemically induced
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D015951:Factor Xa
references.citation: Drug Saf. 2005;28(4):333-49
references.pmid: 15783242
references.citation: Chest. 2008 Jun;133(6 Suppl):141S-159S
references.pmid: 18574264
references.citation: N Engl J Med. 1999 Sep 9;341(11):793-800
references.pmid: 10477777
references.citation: Arch Intern Med. 2005 Feb 14;165(3):341-5
references.pmid: 15710801
references.citation: Drugs Aging. 2007;24(1):63-71
references.pmid: 17233548
references.citation: Circulation. 2004 Aug 17;110(7):874-9
references.pmid: 15289368
references.citation: Clin Interv Aging. 2009;4:165-77
references.pmid: 19503778
references.citation: Semin Thromb Hemost. 2001 Oct;27(5):519-22
references.pmid: 11668422
references.citation: Chest. 2008 Jun;133(6 Suppl):454S-545S
references.pmid: 18574272
references.citation: Circulation. 2004 Jul 27;110(4):392-8
references.pmid: 15249498