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Published on: February 26, 2013
Managing Bleeding Risk in Older Adults: Antithrombotics and Anticoagulants
Francisco B Alexandrino1, Venu Menon2, Grant Reed2
1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Center on Aging Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Clinics in Geriatric Medicine
|May 20, 2026
Summary
Older adults with cardiovascular disease have high risks of blood clots and bleeding. Individualized care, including medication adjustments and adherence, is crucial for managing conditions like atrial fibrillation and venous thromboembolism.
Area of Science:
- Geriatrics
- Cardiology
- Hematology
Background:
- Older adults with cardiovascular disease (CVD) experience a significant burden of thromboembolic disease.
- Biological aging exacerbates both thrombotic and bleeding risks in this demographic.
- Clinical trials often underrepresent elderly patients, limiting evidence-based guidelines.
Purpose of the Study:
- To highlight the complexities of managing thromboembolic disease in older patients with CVD.
- To emphasize the need for individualized treatment strategies.
- To discuss the role of direct oral anticoagulants (DOACs) and bleeding management.
Main Methods:
- Review of current literature on aging, CVD, and anticoagulation.
- Analysis of risk factors for thrombosis and bleeding in elderly populations.
- Discussion of treatment considerations for acute coronary syndrome, atrial fibrillation, and venous thromboembolism.
Main Results:
- Aging increases thrombotic and bleeding risks, necessitating tailored approaches.
- Direct oral anticoagulants (DOACs) offer safety advantages over vitamin K antagonists but need dose adjustments in older adults.
- Effective management of bleeding events and strategic anticoagulation resumption are critical.
Conclusions:
- Individualized strategies, including risk assessment, procedural choices, and medication management, are essential for older patients with CVD.
- A patient-centered approach balancing anticoagulation benefits and bleeding risks is key to optimizing outcomes.
- Careful consideration of medication adherence and dose adjustments for DOACs is vital in geriatric populations.
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