Prevention of thromboembolism in elderly

Abstract

Venous and arterial thrombosis and thromboembolism are a leading cause of suffering in elderly population. The prevalence of venous and arterial thrombosis (formation of blood clot) and thromboembolism (breakage of thrombus to travel somewhere in circulation) is high in elderly population those above 60 years and poses important cause of morbidity and mortality. Annual incidence of venous thrombosis is 1 in 1000 which rises after age of 45 years and arterial thrombosis as high as 20% as per pooled MPN. Spectrum of thromboembolism (TE) is diverse and etiology, and pathogenesis is varied ranging from atrial fibrillation, hypertension, diabetes mellitus (DM), dilated cardiomyopathy and ischemic cardiomyopathy (ICM), congestive heart failure, acute coronary syndrome, and cases of fracture immobilization leading to deep venous thrombosis and pulmonary embolism or else arterial occlusion leading to cardiac or cerebral strokes Aim of the update is to bring a broad overview of the problem to prevent late disastrous outcomes, putting forth two exemplary case studies of imminent TE risk. Case 1 – elderly hypertensive presenting with paroxysmal AF with high CHA2DS visual analog scale score needing anticoagulation and Case 2 – case of DM, post- percutaneous transluminal coronary angioplasty (PTCA), ICM, severe left ventricular (LV) dysfunction with LV thrombus in sinus rhythm needing anticoagulation. Elderly population suffer from diseases of diverse etiology exposing to high risk of TE and at the same time high bleeding risk of the anticoagulants. Elderly population with diverse disease ailments exposed to high risk of TE and bleeding complications and hence should be dealt with utmost care and sympathy to avoid TE and bleeding complications.

Keywords

• anticoagulant
• atrial fibrillation
• left ventricular dysfunction
• new oral anticoagulant
• thromboembolism