. 2019 Dec 27;17:24. doi: 10.1186/s12959-019-0214-8

Table 4.

Practical considerations for treating elderly patients with high risk of VTE

Question	Expert opinion	Guideline recommendations
Are there any practical considerations when treating elderly patients with high risk of VTE, such as specific risk factors, contra-indications, comorbidities or practicalities of administration?	• Higher bleeding risk • Traditional regimens increase the risk of bleeding • The risk of internal bleeding • Need to evaluate the risk of stroke through bleeding • Renal function may be compromised • Dosage due to the reduction in kidney function • Dosage taking into consideration contra-indications • Co-medications • Lack of clinical trials • Affordability is an issue	All recommendations are non-age specific. ACCP/CHEST [28]: • Hepatic failure, severe renal failure, rheumatic disease, current cancer and age ≥ 80 are all independent risk factors for bleeding NICE [38]: • Balance the patient’s risk of VTE against their bleeding risk SIGN [39]: • Patients undergoing total hip replacement with increased risk of bleeding should be given mechanical prophylaxis alone

Question

Expert opinion

Guideline recommendations

Are there any practical considerations when treating elderly patients with high risk of VTE, such as specific risk factors, contra-indications, comorbidities or practicalities of administration?

• Higher bleeding risk

• Traditional regimens increase the risk of bleeding

• The risk of internal bleeding

• Need to evaluate the risk of stroke through bleeding

• Renal function may be compromised

• Dosage due to the reduction in kidney function

• Dosage taking into consideration contra-indications

• Co-medications

• Lack of clinical trials

• Affordability is an issue

All recommendations are non-age specific.

ACCP/CHEST [28]:

• Hepatic failure, severe renal failure, rheumatic disease, current cancer and age ≥ 80 are all independent risk factors for bleeding

NICE [38]:

• Balance the patient’s risk of VTE against their bleeding risk

SIGN [39]:

• Patients undergoing total hip replacement with increased risk of bleeding should be given mechanical prophylaxis alone

ACCP/CHEST, American College of Chest Physicians; NICE, The National Institute for Health and Care Excellence; SIGN, Scottish Intercollegiate Guidelines Network; VTE, venous thromboembolism