Thrombophlebitis and pulmonary embolism in the elderly patient

The incidence of deep venous thrombosis and subsequent pulmonary embolism is increased in the elderly but, because the clinical manifestations may be misleading, the diagnosis is often missed. The clinician must maintain a high index of suspicion and order specific tests for venous thrombosis or pulmonary embolism whenever these diagnoses are considered. Even though the risk of bleeding while anticoagulated is increased in the elderly, treatment with heparin followed by long-term anticoagulation with warfarin is the preferred course of therapy for most patients. Awareness of their increased risk and emphasis on prevention of venous thrombosis may be the most effective means of dealing with this clinical problem in the elderly.