The aging process is associated with increased coagulation and fibrinolysis parameters, resulting in an overall 'prethrombotic state'. This probably explains the increased baseline susceptibility of elderly patients to the development of thromboembolic disease. Additional factors such as major surgery or malignant disease multiply the risk of
thromboembolism in this population. Even when adequate antithrombotic
therapy is instituted, the mortality associated with thromboembolic disease remains considerable; this underlines the importance of adequate thromboembolic prophylaxis. At present, the use of low molecular weight heparins (LMWHs) in elderly immobile patients appears to be the most effective approach to prophylaxis. The use of
compression stockings seems to be effective in the prevention of
venous thrombosis, at least in moderate risk surgical patients. In patients undergoing orthopaedic surgery, additional prophylaxis (e.g. with an
LMWH) is necessary. In the management of
venous thrombosis, patients can initially be treated with a bodyweight-adjusted dosage of an
LMWH. In patients with deep vein leg
thrombosis or
pulmonary embolism, oral
anticoagulant therapy should be started as soon as possible, and should be continued for 6 months. However, before starting prophylaxis or
therapy, an individual risk assessment should be performed in which the benefits and disadvantages are balanced. Most of the large trials that have studied the effects of thromboembolic prophylaxis have focused on postsurgical patients. However, it will be of great interest to develop more specific prophylactic and therapeutic regimens for different nonsurgical high risk subgroups of patients, particularly the elderly.