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[How to anticoagulate elderly and fragile patients?]

Joerg Herold1, Rupert Bauersachs1

  • 1Klinikum Darmstadt, Klinik für Gefäßmedizin-Angiologie.

Deutsche Medizinische Wochenschrift (1946)
|October 20, 2020
PubMed

Insights

Direct oral anticoagulants (DOACs) show superiority in elderly and frail patients, reducing thrombosis and bleeding risks. This review details their effective use in this challenging population.

Area of Science:

  • Cardiovascular Medicine
  • Geriatric Medicine
  • Pharmacology

Background:

  • Increasing age is associated with higher risks of thrombosis, bleeding, and renal impairment.
  • Managing anticoagulation in fragile patients (e.g., >75 years, low creatinine clearance, low body weight) presents significant clinical challenges.
  • Direct oral anticoagulants (DOACs) are increasingly used for anticoagulation.

Purpose of the Study:

  • To summarize new insights into the efficacy and safety of DOACs in fragile patients.
  • To describe optimal anticoagulation strategies for this high-risk group.
  • To address the challenges of using DOACs in elderly and frail individuals.

Main Methods:

  • Review of new registry data.
  • Analysis of subgroup data from landmark studies.
  • Synthesis of current evidence on DOACs in fragile populations.

Main Results:

  • Emerging data suggest DOACs are superior to other anticoagulants in fragile patients.
  • DOACs demonstrate a favorable risk-benefit profile in this population.
  • Registry analyses provide valuable insights into real-world DOAC use.

Conclusions:

  • DOACs represent a safe and effective option for anticoagulation in fragile patients.
  • Evidence supports the use of DOACs in elderly patients with comorbidities.
  • This article provides guidance on anticoagulation pathways for frail individuals.

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