The impact of advanced age on anticoagulant therapy for acute venous thromboembolism

ABSTRACT

Introduction

Management of venous thromboembolic events (VTE) has been completely changed after the introduction of direct oral anticoagulants (DOAC). VTE is common in the geriatric population, but the management of DOACs remains complex because of the lack of specific data in this polymedicated fragile population.

An exhaustive search of anticoagulants in the indication of VTE was performed on PubMed, including data from clinical trials, observational studies, real-world data, drug-drug interaction studies, as well as various guidelines from scientific societies.

Areas covered

The present review aims to summarize our current knowledge on the era of DOACs in the management of VTE in the elderly. This involves learning the pharmacokinetics/pharmacodynamics of drugs specific to geriatrics, the problem of drug-drug interactions, and the main randomized clinical trials validating the use of DOACs.

Expert opinion

DOACs have become an essential part of the management of VTE in the elderly, both for their efficacy and safety. However, we are faced with a list of unmet needs, such as the relevance of DOACs in the very elderly, cancer patients, and those with renal impairment. Clinicians and pharmacists must remain cautious about comedications, as well as about the patient’s comorbidities.

KEYWORDS:

• Elderly
• venous thromboembolism
• direct oral anticoagulant
• pharmacokinetic
• pharmacodynamic
• drug-drug interactions
• geriatric issues

Article highlights

• Aging has a major impact on drug pharmacokinetics affecting the pharmacodynamic properties of direct oral anticoagulants.

• Direct oral anticoagulants’ (DOAC) efficacy and safety (in the treatment of VTE), may be strongly influenced in case of drug-drug interactions (DDI).

• Many specific data are missing to optimize the management of VTE in the elderly (pharmacokinetic data, renal insufficiency, data in the very elderly or in elderly patients with cancer).

This box summarizes key points contained in the article.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.