title: Anticoagulant conversion in the elderly: pitfalls.
abstract: The prevalence of medical conditions representing a risk for thromboembolic complications and requiring antithrombotic therapy increases gradually with age. Two cases of fatal noncritical organ bleeding complication that occurred during the conversion period from initial fondaparinux to vitamin K antagonist are presented. An 81-year-old obese female patient (body mass index 43 kg/m(2)) with previous postoperative thrombosis underwent uneventful total knee replacement under spinal anesthesia. She presented with popliteal hematoma during conversion to oral anticoagulant. A 92-year-old female patient (body mass index 33 kg/m(2)) with left lower limb thrombosis was referred to our orthopedics department from her senior citizens' home for right lower limb hematoma and ischemia that occurred during conversion to oral anticoagulant. Thromboembolic and bleeding events in the elderly are real public health problems. Specific guidelines dedicated to this particular population are needed, which will improve the management of anticoagulation and decrease risk of complications.
authors.affiliation: Clinique du Parc Saint Lazare, 1 et 3 Avenue Jean Rostand, 60000 Beauvais, France. Electronic address: balnasser@orange.fr.
authors.forename: Bassam
authors.initials: B
authors.lastname: Al-Nasser
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D000077425:Fondaparinux; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D009765:Obesity / Q000150:complications; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*; D013927:Thrombosis / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D014812:Vitamin K; D000077425:Fondaparinux
keywords: Anesthesia; Bleeding; Elderly; Fondaparinux; Venous thromboembolism; Vitamin K antagonist