Wednesday, 20. of August 2014
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Anticoagulation therapy in the elderly patient

The plenary sessions were opened by Rebecca J. Beyth, MD, MSc, Associate Professor, University of Florida at Gainesville. She pointed out that anticoagulants are effective in the prevention and management of many thrombo-embolic disorders, which are in general more common in older patients.

Ms. Beyth stated, however, that: “the increased use of anticoagulants in older patients raises concerns about an increased risk of anticoagulant-related bleeding. These concerns may lead clinicians to be less willing to prescribe anticoagulant therapy to older patients who might benefit most from treatment.”

The odds ratio for major bleeding is 3 for patients > 75 years old, compared to those < 65 years of age. “We need to continue to develop better strategies and tools to minimize this risk” said Beyth, and also stated the importance of patient education in teaching basic concepts of safe, effective anticoagulation, discussing the importance of regular INR monitoring, and counseling on the use of other medication and alcohol.

Provider education, on the other hand, should create increased awareness of co-morbidities that may influence the risk of bleeding and the willingness to avoid or limit the use of interacting medication. “There is a need to develop innovative strategies for improving adherence, and to make best use of anticoagulant management models such as dedicated services and clinics, patient self-testing and self-monitoring, as well as computer-assisted dosing” said Beyth. “The essential stratification required to identify those at highest bleeding risk should rely less on subjective impressions, while including assessments of other domains such as functional and cognitive status. Furthermore, the risk needs to be reassessed over time.”

One important statistic: The anticoagulant response to warfarin increases with age. While the average Warfarin daily dose in patients younger than 50 was 6.1 mg/day, it was only 3.5 mg/day in patients older than 80. (James AH et al. J Clin Path 1992;45:701-706).

Report by Thomas Klein, MD, MSc (Nov. 2009)