Deep venous thrombosis treatment in the elderly.

The incidence of deep vein thrombosis and pulmonary embolism is higher in t he elderly due to the greater frequency of risk factors among this age grou p. Classic treatment with heparin and subsequently oral anticoagulant is st ill the most commonly used. Older patients may be at increased risk for ant icoagulant-related bleeding for several reasons: increased anticoagulant ef fect of warfarin, increased prevalence of comorbidity and incidence of adve rse drug reactions. As well as the usual contra-indications to such treatme nt, the psychological and physical well being of the patient must be assume d before an oral anticoagulant can be given. Careful prescribing is require d: a low starting dose, a strict monitoring regime, for a limited duration. The indications for use of an inferior vena cava filter are wider in the o lder age group, not only for those in whom heparin is contraindicated, or h as failed, but also for those who require treatment indefinitely with contr a-indications to oral anticoagulant. Careful consideration of risk factors and the use of an individually designed prophylactic treatment are the best way to tackle this difficult problem in the elderly person.