[Coagulation management in geriatric surgery]

Elderly patients often suffer from cardiovascular diseases and are treated with anticoagulation medications, which must be taken into consideration when planning elective surgery.

The etiology, diagnostic work-up and clinical management of selected inherited and acquired hemophilic and thrombophilic coagulation disorders are described.

Data from clinical studies, current guidelines and expert opinions are discussed.

Beside inherited hemophilic coagulation defects, elderly patients very frequently show an acquired bleeding tendency caused by the intake of analgesic drugs or long-term medication due to cardiovascular diseases. In rare cases, elderly patients can develop acquired hemophilia caused by autoantibodies to coagulation factors resulting in a severe bleeding disorder. Moreover, elderly patients have an increased risk to develop venous or arterial thrombotic events. Prior to surgery a relevant bleeding tendency should be excluded by the combination of medical history, clinical investigation and screening of laboratory parameters. If laboratory parameters are outside the normal range, e.g. a prolonged activated partial thromboplastin time (aPTT), the reasons must be clarified prior to an elective surgery.

The clinical management of elderly patients under anticoagulation treatment should start early and must also cover the post-surgery period. When planning treatment for patients at risk, a physician qualified in clinical hemostaseology should be consulted. For the management of thrombosis prophylaxis, the implementation of clinical guidelines is a valuable measure.