ОСОБЕННОСТИ ПОЖИЛЫХ ПАЦИЕНТОВ: КАК ИХ УЧИТЫВАТЬ ПРИ НАЗНАЧЕНИИ АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ?!

Abstract

Malfunctions in the functioning of the blood coagulation system are often found in elderly patients. Age and the presence of concomitant diseases are not only risk factors for thrombosis, but also increase the likelihood of bleeding. This significantly complicates the problem of choosing anticoagulant therapy. Thus, chronic heart failure, chronic obstructive pulmonary disease, diabetes mellitus, cancer, etc. are established prothrombotic risk factors. Acquired hemophilia and von Willebrand syndrome, factor XI or vitamin K deficiency, thrombocytopenia and thrombocytopathy, on the contrary, may be risk factors for bleeding. Additional difficulties in prescribing anticoagulant therapy to elderly patients arise due to common problems in old age: renal failure, impaired liver function, polypharmacy, etc. However, the presence of these features is not a reason to refuse anticoagulant therapy, since the risk of thrombosis in such patients, as a rule, exceeds the risk of bleeding. This review details the problems that a clinician may face when prescribing anticoagulant therapy to elderly patients and provides recommendations for overcoming them. It is also reported that in the absence of contraindications, direct oral anticoagulants are the best option for the treatment of venous thromboembolic complications.