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Prevention of venous thromboembolism in the geriatric patient
Amir K Jaffer1, Daniel J Brotman
1The Internal Medicine Preoperative Assessment Consultation and Treatment Center, Anticoagulation Clinic, The Cleveland Clinic Foundation, OH 44195, USA. jaffera@ccf.org
Abstract:
Elderly patients immobilized because of an acute medical illness or surgery have a very high risk of developing venous thromboembolism (VTE). Aggressive pharmacologic prophylaxis is necessary and should be initiated either at admission for a medical condition or shortly after surgery. Aggressive prophylaxis may result in fewer patients developing VTE in the hospital and ultimately lead to fewer patients requiring full-dose anticoagulation for VTE. Mechanical prophylaxis can be used as an adjunct to an anticoagulant-based regimen but should only be used as primary prophylaxis when there is a contraindication, such as active bleeding. It is recommended that the clinician carefully evaluate the elderly patient's creatinine clearance and weight before prescribing anticoagulants, particularly when using fixed dosing regimens.
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