Department of Vascular Medicine, Klinikum Darmstadt GmbH, 64283 Darmstadt, Germany.
Thromb Res. 2012 Feb;129(2):107-15. doi: 10.1016/j.thromres.2011.09.013. Epub 2011 Oct 19.
Thromboembolic disorders are a major cause of morbidity and mortality, and the risk of thromboembolism increases with age. Anticoagulants are recommended for indications including the prevention of venous thromboembolism in surgical and medical patients, treatment of venous thromboembolism and stroke prevention in patients with atrial fibrillation. Traditional anticoagulants that have been used include unfractionated heparin, low molecular weight heparin, fondaparinux and vitamin K antagonists. However, these agents are all associated with drawbacks (i.e. parenteral administration or frequent coagulation monitoring/dose titration), and it has been particularly challenging to treat elderly patients with anticoagulants. Some specific characteristics of elderly patients may influence the safety of anticoagulant therapy, such as decreased renal function, co-morbidities and the use of multiple medications. The complexity of anticoagulation therapy and the increased risk of bleeding complications in elderly patients may prevent some physicians from prescribing anticoagulants to these patients, which leaves them at risk of thromboembolic events. Thus, safer and more convenient anticoagulants are needed, particularly for elderly patients. New oral anticoagulants have been developed in recent years and have shown promise in clinical studies that included elderly patients. These agents could simplify the management of thromboembolic disorders and improve the safety of anticoagulation.
血栓栓塞性疾病是发病率和死亡率的主要原因，血栓栓塞的风险随着年龄的增长而增加。抗凝剂推荐用于包括手术和内科患者预防静脉血栓栓塞、治疗静脉血栓栓塞和预防心房颤动患者中风等适应症。传统的抗凝剂包括未分级肝素、低分子量肝素、磺达肝癸钠和维生素 K 拮抗剂。然而，这些药物都存在一些缺点（即需要进行肠外给药或频繁进行凝血监测/剂量调整），因此特别难以用抗凝剂治疗老年患者。老年患者的一些特定特征可能会影响抗凝治疗的安全性，例如肾功能减退、合并症和使用多种药物。抗凝治疗的复杂性以及老年患者出血并发症的风险增加，可能会导致一些医生不愿意为这些患者开抗凝药物，从而使他们面临血栓栓塞事件的风险。因此，需要更安全、更方便的抗凝剂，特别是对于老年患者。近年来开发了一些新型口服抗凝剂，在包括老年患者的临床研究中显示出了良好的前景。这些药物可以简化血栓栓塞性疾病的管理，提高抗凝安全性。
