Antithrombotic pharmacotherapy in the elderly: general issues and clinical conundrums

Antithrombotic pharmacotherapy is an essential component in the pharmacologic arsenal of physicians dealing with diseases at high thromboembolic potential, such as coronary artery disease and atrial fibrillation. Age has a non-negligible impact on the pharmacokinetic and pharmacodynamic effects of antithrombotic medications. Although the benefits of antithrombotic pharmacotherapy in the elderly are well established, the elderly are generally more vulnerable to the adverse effects of antithrombotic drugs, particularly bleeding. Factors that may affect therapeutic agents in general (e.g., renal function, hepatic metabolism, body mass distribution) as well as factors more specific to thrombosis and hemostasis (e.g., platelet dysfunction, coagulation disorders) may partially account for such higher vulnerability, demanding careful consideration. The lack of studies performed specifically in the elderly and their under-representation in many large-scale clinical trials often lead guidelines to give neutral recommendations or even arbitrary assumptions. The development of novel antithrombotic agents with a more favorable safety profile may have a promising role in the ever-growing population of elderly individuals.