Anticoagulation in the Elderly

  • Ruchika Harisingani
  • Ibrahim M. Ali
  • Bhakti Shah
  • Salonie Pereira


With an aging population comes an increasing prevalence of cardiovascular diseases such as atrial fibrillation and coronary artery disease. Anticoagulation is a cornerstone of therapy to prevent stroke in patients with atrial fibrillation. Antiplatelet therapy is essential for the primary and secondary prevention of ischemic heart disease. Since anticoagulants and antiplatelet agents are associated with increased risks of bleeding, it is important for clinicians to weigh the risks and benefits of these medications in the elderly. In this chapter, we review the age-associated changes in drug metabolism via three clinical scenarios commonly encountered in the management of anticoagulation therapy in the geriatric patient:
  • Use of direct oral anticoagulants in the elderly

  • Risk of intracranial bleeding in the elderly

  • An elderly patient on triple therapy (warfarin, aspirin, clopidogrel)

We also briefly discuss the topics of discontinuing these agents when clinically appropriate and the non-pharmacological management of atrial fibrillation.


Elderly Anticoagulation Atrial fibrillation Coronary heart disease Bleeding Falls Direct oral anticoagulants 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ruchika Harisingani
    • 1
  • Ibrahim M. Ali
    • 2
  • Bhakti Shah
    • 1
  • Salonie Pereira
    • 1
  1. 1.Department of MedicineNorthwell Health, Zucker School of Medicine at Hofstra/NorthwellManhassetUSA
  2. 2.Department of CardiologyNorthwell Health, Zucker School of Medicine at Hofstra/NorthwellManhassetUSA

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