Blutungskomplikationen bei geriatrischen Patienten unter oraler Antikoagulation – Aspekte der Polypragmasie

Abstract

Oral anticoagulant therapy has been shown to be of benefit also in elderly patients in various therapeutic and prophylactic indications. Despite strong evidence in literature, doctors still refuse to prescribe oral anticoagulants to geriatric patients in daily routine. Main reason for this decision is the fear of secondary bleeding complications. According to clinical trial data, distinct risk factors for bleeding attributed to anticoagulant treatment may be determined: age >70 years, female gender, recurrent bleeding events, alcohol/drug abuse, diabetes, anaemia and polypharmacy. The entire article reveals the literature in Medline and Cochrane Library from 1980 to 2009 including the hits "polypharmacy - anticoagulant treatment - elderly patients". It further highlights risk assessment strategies in elderly patients, and possible pharmacokinetic and -dynamic interactions of drugs co-administered with oral anticoagulants.

Efficacy and Safety of Rivaroxaban for Extremely Aged Patients with Venous Thromboembolism: A Retrospective, Cross-Sectional Real-World Study

“… 18 , 28 Because of the age-related physiological changes, comorbidities, and concomitant medications, the anticoagulation in elderly patients is challenging and associated with an increased risk of adverse events. 15 , 17 Many clinical trials of anticoagulant therapy have excluded older patients, and it is controversial whether older patients are at higher risk for bleeding during anticoagulant therapy than are younger patients. Some researchers think that age alone is not a contraindication for full dose anti-coagulation, but few prescribers made no dose adjustment in rivaroxaban in real-world practice.…”

“…14 The risk of bleeding during anticoagulation is generally higher in the elderly for several reasons. 15 , 16 First, they have reduced metabolic clearance due to a high incidence of renal or hepatic impairment. Second, they have an increased prevalence of comorbidity and polypharmacy.…”