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

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
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
  1. ACCP/CHEST, American College of Chest Physicians; ACS, acute coronary syndrome; DOAC, direct oral anticoagulant; DVT, deep vein thrombosis; GI, gastrointestinal; LMWH, low-molecular-weight heparin; NICE, The National Institute for Health and Care Excellence; PE, pulmonary embolism; SIGN, Scottish Intercollegiate Guidelines Network; VTE, venous thromboembolism