title: Venous thromboembolism in the elderly: efficacy and safety of non-VKA oral anticoagulants.
abstract: Increasing age and renal impairment are risk factors for venous thrombosis but also for anticoagulant-induced bleeding. In large-scale phase III trials, non-VKA oral anticoagulants (NOACs) were at least as effective and safe for the treatment of acute venous thromboembolism as warfarin. Here, we review the efficacy and safety of dabigatran, rivaroxaban, apixaban and edoxaban in the subgroups of elderly patients (≥75 years) and patients with impaired renal function (creatinine clearance ≤50 ml/min). In all phase III trials, the efficacy of NOACs in the prevention of recurrent VTE was conserved both in the elderly subgroup and in the subgroup with impaired renal function. In a meta-analysis of the pooled results, NOACs reduced VTE recurrence compared with warfarin in elderly patients. In elderly patients and patients with impaired renal function, the safety of NOACs was in line with the results of the overall study. NOACs may offer an effective, safer and more convenient alternative for VKAs also in the elderly. However, the efficacy/safety profile of NOACs in the aged population needs to be confirmed in real-life.
authors: Division of Internal Medicine, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium.
authors: Vincent
authors: V
authors: Geldhof
authors: Vascular Medicine and Haemostasis, Division of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium.
authors: Christophe
authors: C
authors: Vandenbriele
authors: Vascular Medicine and Haemostasis, Division of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium.
authors: Peter
authors: P
authors: Verhamme
authors: Vascular Medicine and Haemostasis, Division of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium ; Center for Molecular and Vascular Biology (CMVB), Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven B3000, Belgium.
authors: Thomas
authors: T
authors: Vanassche
keywords: Elderly; Non-VKA-acting oral anticoagulants; Novel oral anticoagulants; Renal insufficiency; Venous thromboembolism
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