[Anticoagulation in the elderly].
The recommendations for anticoagulation in over 80 years old patients are based on the thromboembolic/bleeding risk relation. They add to the published recommendations for the specific indications. Low-molecular-weight heparin (LMWH) is used to prevent thromboembolism postoperatively. Compression stockings and/or intermittent pneumatic compression are used if bleeding risk is very high. The dose is increased starting at day two if the thromboembolic risk is very high. Bleeding and thromboembolic risks are re-evaluted daily. The antithrombotic therapy is adjusted accordingly. Prophylaxis of thromboembolism in patients with acute illnesses and bedrest is performed according postoperative care. Two-thirds of therapeutic doses of low-molecular-weight heparin are used to treat acute venous thromboembolism. Reduced renal function (creatinine clearance <30 ml/ min for most LMWHs or <20 ml/min for tinzaparin) should result in a further reduction of dose. Intensity and duration of prophylaxis of recurrent events with vitamin K antagonist or LMWH in malignancy follow current or herein described recommendations. Patients with atrial fibrillation are treated with vitamin K antagonists adjusted to an INR of 2-3 for prophylaxis of embolism. Further details of anticoagulant therapy should be in agreement with the national or international recommendations.
Harenberg
J
J
Klinische Pharmakologie Mannheim, Ruprecht-Karls-Universität Heidelberg, Maybachstraße 14, 68169, Mannheim. job.harenberg@medma.uni-heidelberg.de
Bauersachs
R
R
Diehm
C
C
Lawall
H
H
Burkhardt
H
H
Gerlach
H
H
Darius
H
H
Völler
H
H
Rabe
E
E
Wehling
M
M
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006470:Hemorrhage / Q000139:chemically induced*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D007677:Kidney Function Tests; D009369:Neoplasms / Q000150:complications; D011183:Postoperative Complications / Q000188:drug therapy; D012307:Risk Factors; D055502:Secondary Prevention; D053828:Stockings, Compression; D013923:Thromboembolism / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K
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