Anticoagulant Therapy in Very Old Patients

Older patients are less likely than younger patients to receive anticoagulation and are more likely to be underanticoagulated. Although the use of warfarin in the elderly has been increasing, fewer than half of eligible patients take warfarin. Evidence suggests that stroke recurrence in patients on oral anticoagulation is mainly ischemic, and hemorrhagic complications that derive from oral anticoagulation would be related to overdosing. Several risk factors for developing hemorrhagic complications have been described, and clinical criteria have been designed to help clinicians in decision-making concerning the start of anticoagulation treatment. Finally, given the promising results of recent studies on new anticoagulant drugs, it is possible that vitamin K antagonists will be replaced in the coming years.