Venous Thromboembolism in the Elderly

Abstract

Aging is a major risk factor for venous thromboembolism. Compared to the general population, the elderly have a much higher 1-year mortality from venous thromboembolism (VTE). Clinical presentation of VTE in the elderly tends to be different, with atypical symptoms being more common than in the general population. Diagnostic work-up starts with establishing a VTE pretest probability followed by D-dimer testing for patients with low pretest probability and confirmatory testing for patients with high pretest probability of VTE. The age-adjusted D-dimer cutoffs are associated with a higher specificity without compromising the test's sensitivity. Anticoagulation is the cornerstone of VTE therapy. The use of novel oral anticoagulants is safe in elderly patients and is associated with a decreased risk of bleeding.

Age Is a Risk Factor for Postoperative Complications Following Excisional Laminectomy for Intradural Extramedullary Spinal Tumors

“…53,54 In addition, the risk of deep venous thrombosis without any prophylactic measures are 25% for general surgery and 22% for neurosurgery. 53,54,57 Patient preoperative morbidity as indicated by the ASA score may help explain why elderly patients (>55 years) were more likely to demonstrate a higher mortality rate and postoperative cardiac complications in univariate analysis of our data. Many of the patients in our study have an ASA score >3, and a higher ASA physical status class generally describes an individual who has more comorbidities, translating into longer hospital stay, higher postoperative mortality rate, and higher risk of myocardial injury.…”

“…22 In elderly patients, up to 10% to 20% of immediate death is due to VTE, and fatal pulmonary embolism is a preventable VTE consequence that accounts for 1% death of hospitalized patients. 53-57 According to recommended guidelines, patients in our study would be considered high risk as they demonstrate high-risk factors such as age >60 years, acute chronic lung or inflammatory disease, decompensated heart failure, active cancer, and >40 years with a major surgery >45 minutes. 53,54,57 Medical prophylactics for high-risk patients generally include low-dose unfractionated heparin, low-molecular-weight heparin (enoxaparin and dalteparin), and fondaparinux.…”

“…53-57 According to recommended guidelines, patients in our study would be considered high risk as they demonstrate high-risk factors such as age >60 years, acute chronic lung or inflammatory disease, decompensated heart failure, active cancer, and >40 years with a major surgery >45 minutes. 53,54,57 Medical prophylactics for high-risk patients generally include low-dose unfractionated heparin, low-molecular-weight heparin (enoxaparin and dalteparin), and fondaparinux. With high-risk patients, the use of intermittent pneumatic compression over graduated compression stocking is viewed as a more effective mechanical prophylactic device.…”

“…53,54 In addition, the risk of deep venous thrombosis without any prophylactic measures are 25% for general surgery and 22% for neurosurgery. 53,54,57…”

Coagulation and Aging: Implications for the Anesthesiologist

“…Potentially of even higher interest, the incidence of venous thromboembolism (VTE) greatly increases in the elderly population (> 75 years) by about factor 6 (for pulmonary embolism) to 10 (for deep venous thrombosis) compared to younger people (< 40 years) [5]. In fact, the majority of all VTEs occur in patients aged > 70 years [26][27][28]. Recurrent and fatal VTE are a major clinical concern in the elderly [3•, 15].…”