Table 5 Subgroups of elderly patients for whom LMWH may be the optimal choice

In which subgroups of elderly patients would you consider LMWHs, such as enoxaparin, the optimal choice?

• Only if the patient has a specific condition

• In patients with cancer and VTE

• In patients with ACS

• Used in percutaneous coronary interventions, ACS and thrombolytic therapy

• Those with a history of internal bleeding

• LMWH preferred due to the ability to change dosage based on kidney function and age

• Intermediate risk PE

• Patients with acute PE who do not use DOACs

• Patients with comorbidities, GI problems and chronic inflammatory disease

• Patients with provoked VTE post-operatively

• LMWH used with inpatients but not used with outpatients

All recommendations are non-age specific.

ACCP/CHEST [28]:

• Acutely ill hospitalised patients at increased risk of thrombosis

• Critically ill patients

• Outpatients with solid tumours who have additional risk factors for VTE and low bleeding risk

NICE [38]:

• Patients with renal impairment needing pharmacological VTE prophylaxis

• People with myeloma or pancreatic cancer receiving chemotherapy

• People receiving palliative care

• Those admitted to the critical care unit

• 1 month of VTE prophylaxis for patients with fragility fractures of the pelvis, hip or proximal femur

• 10 days of LMWH for people undergoing elective hip replacement surgery

• 7 days minimum VTE prophylaxis with LMWH for patient undergoing open vascular surgery or major endovascular procedures, lower limb amputation

SIGN [39]:

• Patients undergoing total hip replacement should receive prophylaxis with LMWH

• Patients with cancer and cancer surgery

• In patients with non-haemorrhagic stroke at high risk of VTE

• Patients with suspected PE or DVT should receive therapeutic doses