Antithrombotic Therapy in Older Adults in Long-term Care
Antithrombotic Therapy in Older Adults in Long-term Care
Older adults living in nursing facilities pose a particularly unique problem for medical practitioners with regard to antithrombotic therapy. Physicians are more disposed to initiate and maintain residents on aspirin because this medication poses minimal risk. Our data show that most residents were receiving aspirin. Physicians were more cautious when prescribing anticoagulants such as warfarin, dabigatran, heparin, and enoxaparin, given the major bleeding risk, especially in the frail, older population. In some residents, anticoagulants were not used at all, even when residents had specific risk factors. At times, physicians tend to be overcautious. Antithrombotic therapy for older adults should be individualized for each person based on bleeding risk, comorbidities, and benefits of particular therapy.
Conclusions
Older adults living in nursing facilities pose a particularly unique problem for medical practitioners with regard to antithrombotic therapy. Physicians are more disposed to initiate and maintain residents on aspirin because this medication poses minimal risk. Our data show that most residents were receiving aspirin. Physicians were more cautious when prescribing anticoagulants such as warfarin, dabigatran, heparin, and enoxaparin, given the major bleeding risk, especially in the frail, older population. In some residents, anticoagulants were not used at all, even when residents had specific risk factors. At times, physicians tend to be overcautious. Antithrombotic therapy for older adults should be individualized for each person based on bleeding risk, comorbidities, and benefits of particular therapy.