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Table 4 Practical considerations for treating elderly patients with high risk of VTE

From: Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

QuestionExpert opinionGuideline 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
  1. ACCP/CHEST, American College of Chest Physicians; NICE, The National Institute for Health and Care Excellence; SIGN, Scottish Intercollegiate Guidelines Network; VTE, venous thromboembolism