Anticoagulants in the elderly - Indications

Risk and benefit: The beneficial effect of anticoagulant treatment is well established by numerous therapeutic trials demonstrating its usefulness in two main indications (venous thromboembolism and complete arrhythmia due to atrial fibrillation) in selected populations. Very few trials have been sp ecifically conducted in elderly subjects and the increased risk of thrombos is and anticoagulant related bleeding cannot be used to extrapolate the res ults to elderly subjects. For this reason, a careful assessment of the init ial risk and expected benefit must be made for each individual patient usin g a validated and systematic global evaluation system adapted for elderly s ubjects in order to better discern the indications and the risk of hemorrha ge. Perspectives: The development of anticoagulation clinics, based on the meth od initiated by Professor Boneu at Toulouse, together with clinical trials designed to produce results transposable to the diverse and complex geriatr ic population, and finally the development of new oral compounds not requir ing laboratory tests under the same conditions should help reduce the thera peutic risk for an equivalent benefit.