In this review, the authors illustrate common challenges with anticoagulant use in older patients by describing five clinical cases and discussing how they decide upon the most appropriate antithrombotic therapy in those clinical situations.
Anticoagulant therapy is the most effective strategy to prevent arterial and venous thromboembolism but treating older individuals is challenging because increasing age, comorbidities and polypharmacy increase the risk of both thrombosis and bleeding. Warfarin and the non-vitamin K antagonist oral anticoagulants are underused and often under-dosed in the prevention of stroke in older patients with atrial fibrillation because of concerns about the risk of bleeding. Poor adherence to anticoagulant therapy is also an issue for older patients with atrial fibrillation and for those at risk of recurrent pulmonary embolism. In this review, we present 5 clinical cases to illustrate common challenges with anticoagulant use in older patients and discuss our approach to institute safe and effective antithrombotic therapy.