The Challenges of Managing Deep Vein Thrombosis in the Elderly: A Narrative Review

Abstract

Elderly people have a higher risk of deep vein thrombosis (DVT) than younger adults. The causes of this are considered multifactorial, including changes in age-related hemostatic factors, greater comorbid conditions, and the frequency of hospitalizations, although they are not fully understood. Besides, DVT in the elderly can be difficult to recognize because the symptoms can appear atypically. The diagnostic approach of DVT remains the same for all age groups, including pre-test probability, D-dimer measurement, and imaging, although these can be less specific in older age. Antithrombotic agents are the main treatment of DVT. Direct oral anticoagulation (DOAC) provides clinicians with more choices for DVT therapy. However, the anticoagulation of DVT in the elderly must always be done carefully, because old age is also a risk factor for the occurrence of bleeding complications. Identifying bleeding risk factors that can be modified and balancing the risk of thrombosis with bleeding, including the selection and adjustment of anticoagulant doses, are important in considerations of using anticoagulants in the elderly. This narrative review summarizes the literature on the management of DVT in the elderly