LACK OF EXCESSIVE BLEEDING RISK IN ELDERLY PATIENTS RECEIVING LONG-TERM ORAL ANTICOAGULATION

Background: Oral anticoagulant therapy is indicated to prevent thrombo embolic complications in a variety of cardiovascular disorders that ar e common in elderly patients. Few studies specifically address the ris k:benefit ratio of long-term oral anticoagulation in an elderly popula tion. Methods: Hospital records of 177 patients over 70 years of age a ttending the outpatient Coumadin Clinic of a large public metropolitan hospital were reviewed. Major and minor bleeding events and thromboem bolic events were tabulated, as were potentially contributing comorbid factors. The study was designed to examine the clinical predictors of these adverse events and, by stratifying elderly patients by age, to evaluate age as an independent predictor of risk. Results: In elderly patients stratified for age, neither sex, number of concomitant drugs used, nor duration of anticoagulant use were predictors of complicatio ns. Multivariate predictors of major bleeding complications were cereb rovascular accident, as the indication for anticoagulation, and histor y of peptic ulcer disease, as a comorbid illness. Pulmonary embolism, as the indication for anticoagulation, and chronic renal failure and p eptic ulcer disease, as comorbid illnesses, suggested thromboembolic c omplications. Conclusion: Elderly age alone is not a contraindication to oral anticoagulation; comorbid factors may help guide patient selec tion.