skip to content
Dovepress - Open Access to Scientific and Medical Research
View our mobile site

8830

A need for evidence-based clinical practice guidelines for the use of heparins in the elderly

Commentary

(2372) Views  (776) Full article downloads

Authors: Isabelle Gouin-Thibault, Virginie Siguret, Eric Pautas

Published Date April 2010 Volume 2010:5 Pages 119 - 121
DOI: http://dx.doi.org/10.2147/CIA.S9760

Isabelle Gouin-Thibault1,2, Virginie Siguret1,2, Eric Pautas2,3

1Assistance Publique Hôpitaux de Paris, Laboratoire d’Hématologie, Hôpital Charles Foix, Paris, France; 2Université Paris Descartes, INSERM U, Paris, France; 3Assistance Publique Hôpitaux de Paris, Unité de Gériatrie Aiguë, Hôpital Charles Foix, Paris, France

Abstract: Low-molecular-weight heparins (LMWHs) have been widely studied in pivotal clinical trials or in several meta-analyses. However, the safety and optimal use of LMWHs in high-risk patients such as the very elderly remains uncertain since these patients are usually excluded from clinical trials. In terms of LMWHs in the elderly, the main concerns are renal failure and the risk of accumulation. A clinical approach consisting of a LMWH dose reduction in the elderly should be considered with great caution in terms of efficacy, since it has been tested neither in the treatment of VTE nor in VTE prophylaxis. If monitoring is considered in patients receiving therapeutic dose LMWHs, appropriate target ranges for peak anti-Xa activity levels should be used and so far, no anti-Xa activity-based guidelines have been issued. Moreover, no data support any laboratory monitoring in elderly patients treated with prophylactic dose LMWHs.

Keywords: elderly patients, low-molecular-weight heparin, renal insufficiency, evidence-based medicine








Readers of this article also read:

Maintenance treatment with infliximab for the management of Crohn’s disease in adults
Use of anticoagulants in elderly patients: practical recommendations
Role of aliskiren in cardio-renal protection and use in hypertensives with multiple risk factors
Update on the management of constipation in the elderly: new treatment options
Anesthesiologists’ perception of patients’ anxiety under regional anesthesia
Vasogenic shock physiology
Economic considerations of antifungal prophylaxis in patients undergoing surgical procedures
Antimicrobial prophylaxis in open lower extremity fractures
Antioxidant oils and Salmonella enterica Typhimurium reduce tumor in an experimental model of hepatic metastasis
Cumulative clinical experience from over a decade of use of levofloxacin in community-acquired pneumonia: critical appraisal and role in therapy