Review Article

Drugs & Aging

, Volume 14, Issue 4, pp 303-312

First online:

Safety of Treatment with Oral Anticoagulants in the Elderly

A Systematic Review
  • Barbara A. HuttenAffiliated withDepartment of Clinical Epidemiology and Biostatistics, University of Amsterdam Email author 
  • , Anthonie W. A. LensingAffiliated withDepartment of Vascular Medicine, Academic Medical Center, University of Amsterdam
  • , Roderik A. KraaijenhagenAffiliated withDepartment of Vascular Medicine, Academic Medical Center, University of Amsterdam
  • , Martin H. PrinsAffiliated withDepartment of Clinical Epidemiology and Biostatistics, University of Amsterdam

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Abstract

Oral anticoagulants have documented efficacy for many indications and are widely used in elderly patients. However, there is concern about whether this treatment induces an excess of major bleeding in elderly patients. In this system atic review, the incidence of oral anticoagulant-related major bleeding among elderly patients was determined.

A total of 58 reports were identified that evaluated an oral anticoagulant, included patients with a mean age of at least 60 years, and provided data on the occurrence of major bleeding or provided separate data on the occurrence of major bleeding in elderly versus younger patients.

In 50 studies no age differentiation was given. Although the incidence of bleeding complications varied, a trend towards increased bleeding with increas ing age was shown in patients with major orthopaedic surgery and cardiac dis eases. In the 8 articles that provided separate data on the occurrence of bleeding in different age categories, there was a clear tendency towards a 2-fold increase in bleeding in elderly patients.

These findings emphasise the need for caution in the use of oral anticoagulants in elderly patients. However, the decision to start oral anticoagulant treatment should be based on an evaluation of the risk/benefit balance on a careful patient-by-patient basis. In general, if oral anticoagulant treatment is started, the lowest possible effective International Normalised Ratios (INR) should be selected and regular monitoring should be done to avoid over-anticoagulation.