Dinwoodey Danya L, Ansell Jack E
Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
Clin Geriatr Med. 2006 Feb;22(1):1-15, vii. doi: 10.1016/j.cger.2005.09.007.
Elderly patients require special consideration when administered anticoagulants because of age-related alterations in renal function, protein binding, and increased bleeding risk. Unfractionated heparin can be used in most patients but difficulties with dosing and monitoring often lead to inadequate anticoagulation. Low-molecular-weight heparin has more predictable pharmacokinetics than conventional heparin, but requires dose adjustments in renal impairment and obesity. Fondaparinux is a synthetic pentasaccharide that is being used increasingly for both treatment and prophylaxis of venous thromboembolism. The immune-mediated form of heparin-induced thrombocytopenia is a syndrome with thrombocytopenia or thrombosis in the setting of heparin use. Heparin-induced thrombocytopenia must be identified early, and treated with argatroban or lepirudin to avoid life-threatening complications.
由于肾功能、蛋白结合存在与年龄相关的改变以及出血风险增加，老年患者在使用抗凝剂时需要特别考虑。大多数患者可使用普通肝素，但给药和监测困难常导致抗凝不足。低分子量肝素的药代动力学比传统肝素更可预测，但在肾功能损害和肥胖患者中需要调整剂量。磺达肝癸钠是一种合成的五糖，越来越多地用于静脉血栓栓塞的治疗和预防。免疫介导型肝素诱导的血小板减少症是一种在使用肝素时出现血小板减少或血栓形成的综合征。必须尽早识别肝素诱导的血小板减少症，并用阿加曲班或比伐卢定进行治疗，以避免危及生命的并发症。
