Abstract
There is a growing proportion of the elderly population in the Western world, and
these individuals require special considerations regarding a broad variety of aspects,
including treatment approaches to illnesses that affect all age groups. The hemostatic
system in individuals changes considerably with aging. Specifically, changes in levels
of procoagulant and natural anticoagulant factors along with thrombopathy simultaneously
create a hypercoagulable state and hemostatic difficulties. Underlying morbidities,
such as congestive heart failure, chronic obstructive pulmonary disease, diabetes
mellitus, and cancer, increase the risk for venous and arterial thrombosis. This population
is also increasingly affected by acquired bleeding disorders, including acquired hemophilia
and acquired von Willebrand syndrome, as well as mild congenital bleeding disorders.
Real-life data demonstrate that recurrent and fatal venous thromboembolism is the
major hemostatic concern in the elderly. The fact that treatment of thrombotic complications
increases the bleeding risk also has to be taken into consideration, particularly
in the older age group. This remains true in the era of direct oral anticoagulants.
In conclusion, maintaining a delicate balance between thrombosis and bleeding risks
is the key issue in providing qualified treatment to elderly patients.
Keywords
elderly - thrombosis - bleeding - comorbidities
