Anticoagulants in the elderly - Age-related factors

Heparins: For unfractionated heparins, certain studies have demonstrated in creased hemorrhage rates correlated with age and with renal function. Subcu taneous injections every 12 hours are as effective and less uncomfortable f or the patient than continuous intravenous infusions. Low-molecular-weight heparins are currently contraindicated for curative treatment and their use is not recommended for prevention when the creatinine clearance is below 3 0 ml/min. Other anticoagulants: The dosage of sodium daparanoid should be adapted to the renal function with regular surveillance of anti Xa activity. With hiru din, there is a risk of product accumulation in case of renal failure. For oral anticoagulants the relationship between old age and the frequency of h emorrhagic complications is still a subject of debate. Oral anticoagulants: The starting dosage should be reduced to one-half or o ne-quarter of the usual dose. The INR should be measured regularly, particu larly since elderly subjects are highly susceptible to wide variations in I NR irrespective of the cause. It is also advisable to carefully determine a ppropriate situations when oral coagulants should be used.