Prevention of venous thromboembolism in the geriatric patient

Elderly patients who are immobilized because of an acute medical illness or surgery have a very high risk of developing VTE. Aggressive pharmacologic prophylaxis is necessary and should be initiated either at admission for a medical condition or shortly after surgery. Aggressive prophylaxis may result in fewer patients developing VTE in the hospital and ultimately lead to fewer patients requiring full-dose anticoagulation for VTE. Mechanical prophylaxis can be used as an adjunct to an anticoagulant-based regimen but should only be used as primary prophylaxis when there is a contraindication to pharmacologic prophylaxis, such as active bleeding. Recommendations regarding type and duration of prophylaxis for the various conditions are summarized in Table 1. Finally, the authors recommend the clinician carefully evaluate the elderly patient's creatinine clearance and weight before prescribing anticoagulants, particularly when using fixed dosing regimens.