Therapeutic anticoagulation complications in the elderly: a case report

Area of Science:

• Geriatric Medicine
• Nephrology
• Pharmacology

Background:

• The demographic transition is increasing the number of elderly patients requiring therapeutic anticoagulation for comorbidities.
• Anticoagulation in elderly patients, particularly those with chronic kidney disease (CKD), presents a limited evidence base for agent selection.
• Guideline-based anticoagulation may lead to severe bleeding complications, necessitating careful risk-benefit assessment.

Observation:

• An 85-year-old female patient with stage V CKD experienced a massive atraumatic subcutaneous bleeding in her lower leg while on therapeutic anticoagulation with low molecular weight heparin (LMWH).
• The bleeding resulted in hemorrhagic shock, acute kidney injury superimposed on CKD, and required surgical evacuation and multiple interventions.
• The patient underwent extensive treatment including surgical evacuation, skin grafting, continuous renal replacement therapy, and intensive care unit stay.

Findings:

• Therapeutic anticoagulation with LMWH, even when dosed for renal function, can precipitate severe bleeding complications in elderly patients with advanced CKD.
• This case demonstrates a fulminant bleeding event leading to significant morbidity, prolonged hospitalization, and intensive care management.
• The complication necessitated multiple surgical interventions and extensive supportive care, including renal replacement therapy.

Implications:

• Physicians must regularly re-evaluate the indication for anticoagulation in elderly patients, especially those with CKD, due to the risk of major bleeding.
• There is a critical need for more differentiated study settings focusing on geriatric patients to optimize anticoagulation strategies and prevent avoidable complications.
• This case underscores the importance of individualized treatment approaches and vigilant monitoring in anticoagulated elderly patients with renal impairment.