Table 4 Practical considerations for treating elderly patients with high risk of VTE
Question | Expert opinion | Guideline recommendations |
|---|---|---|
Are there any practical considerations when treating elderly patients with high risk of VTE, such as specific risk factors, contra-indications, comorbidities or practicalities of administration? | • Higher bleeding risk • Traditional regimens increase the risk of bleeding • The risk of internal bleeding • Need to evaluate the risk of stroke through bleeding • Renal function may be compromised • Dosage due to the reduction in kidney function • Dosage taking into consideration contra-indications • Co-medications • Lack of clinical trials • Affordability is an issue | All recommendations are non-age specific. ACCP/CHEST [28]: • Hepatic failure, severe renal failure, rheumatic disease, current cancer and age ≥ 80 are all independent risk factors for bleeding NICE [38]: • Balance the patient’s risk of VTE against their bleeding risk SIGN [39]: • Patients undergoing total hip replacement with increased risk of bleeding should be given mechanical prophylaxis alone |