Consideration of Anticoagulation: Surgical Care for the Elderly in Current Geriatrics Reports

Abstract

The geriatric population in the USA is growing at a dramatic rate. As this segment of the population increases in number, surgical providers will increasingly treat and evaluate patients with age-specific needs that affect surgical or trauma management. Consequently, surgeons should be familiar with trends in prescribing oral anticoagulants (OACs), their association with outcomes, and the guidelines for reversing and prescribing these medications. Warfarin was the only oral anticoagulant available in the USA until 2010 when non-vitamin K antagonist oral anticoagulants (NOACs) were introduced to the market. Since then, they have rapidly gained a majority of the US market share. The implications of NOAC use on bleeding complications such as in traumatic brain injury (TBI) are unclear, but evidence suggests that NOACs may be safer than warfarin. Guidelines for anticoagulation reversal in life-threatening bleeding associated with warfarin are well established, but optimal utilization is evolving for most NOAC agents. The use of anticoagulation therapy has changed dramatically over the last decade. These changes are multifactorial and include the increasing prevalence of OAC use, and the introduction of NOACs. Consequently, challenges associated with managing OAC in the elderly will only become more complicated over time. Surgical providers need to be aware of these changes and update their practice on the shifting epidemiology of this population, evolving guidelines, and new reversal agents.