Drugs & Aging

, Volume 33, Issue 7, pp 491–500 | Cite as

Minimizing the Risk of Bleeding with NOACs in the Elderly

  • Amartya Kundu
  • Partha SardarEmail author
  • Saurav Chatterjee
  • Wilbert S. Aronow
  • Theophilus Owan
  • John J. Ryan
Review Article


Novel oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban have gained a lot of popularity as alternatives to warfarin for anticoagulation in various clinical settings. However, there is conflicting opinion regarding the absolute benefit of NOAC use in elderly patients. Low body mass, altered body composition of fat and muscle, renal impairment and concurrent presence of multiple comorbidities predispose elderly patients to many adverse effects with NOACs that are typically not seen in younger patients. There have been reports that NOAC use, in particular dabigatran, is associated with a higher risk of gastrointestinal bleeding in the elderly. Diagnosis and management of NOAC-associated bleeding in the elderly is difficult due to the absence of commonly available drug-specific antidotes that can rapidly reverse the anticoagulant effects. Moreover, in elderly patients, a number of factors such as the presence of other comorbid medical conditions, renal insufficiency, drug interactions from polypharmacy, risk of falls and dementia need to be considered before prescribing anticoagulation therapy. Elderly patients frequently have compromised renal function, and therefore dose adjustments according to creatinine clearance for NOACs need to be made. As each NOAC comes with its own unique advantages and safety profile, an individualized case by case approach should be adopted to decide on the appropriate anticoagulation regimen for elderly patients after weighing the overall risks and benefits of therapy.


Atrial Fibrillation Warfarin International Normalize Ratio Dabigatran Major Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards

Conflict of interest

All authors declare they have no conflicts of interest that are relevant to the content of this review.


All authors declare that no sources of funding were used to assist with the preparation of this review.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Amartya Kundu
    • 1
  • Partha Sardar
    • 2
    Email author
  • Saurav Chatterjee
    • 3
  • Wilbert S. Aronow
    • 4
  • Theophilus Owan
    • 2
  • John J. Ryan
    • 2
  1. 1.Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Division of Cardiovascular Medicine, University of Utah Health Science CenterUniversity of UtahSalt Lake CityUSA
  3. 3.Division of CardiologySt. Luke’s-Roosevelt Hospital of the Mount Sinai Health SystemNew YorkUSA
  4. 4.Division of CardiologyNew York Medical CollegeValhallaUSA

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