Physiological changes due to age. Implications for the prevention and treatment of thrombosis in older patients.

The risk of venous thromboembolism increases with age. This increasing risk is associated with a concurrent enhancement of coagulation activation and gradual development of a 'prethrombotic state'. This is reflected by increased levels of coagulation activation peptides in the elderly, as well as decreased activity of the fibrinolytic system. Moreover, with increasing age there is an increased incidence of comorbid conditions, which may, in themselves, be associated with an increased risk for the development of thrombosis. Accurate diagnostic techniques and strategies for treatment and prevention of deep vein thrombosis (DVT) are mandatory in order to prevent potentially fatal complications of DVT, such as pulmonary embolism. The feasibility of validated diagnostic techniques for detecting DVT, such as real-time B-mode ultrasonography, impedance plethysmography and contrast venography, is not significantly hampered in elderly patients. The same applies to strategies for prophylaxis and treatment of DVT, which are similar to those for younger patients, although formal studies in elderly patients with DVT are lacking.