Learning Objectives

  • Explain the age-related challenges involved in considering anticoagulation for acute VTE

  • Identify the best treatment strategy for acute VTE in older patients with chronic renal disease and low weight

A 76-year-old woman with a past medical history of coronary artery disease and on chronic therapy with aspirin presents to the emergency room with right lower extremity pain and swelling. A venous duplex ultrasound showed an acute thrombus involving the right common femoral vein. Her hemoglobin is 11.5  mg/dL and platelet count is 158,000/uL. Her weight is 58  kg, and her serum creatinine is 1.3  mg/dL (estimated creatinine clearance [CrCl] of 36  mL/min). What anticoagulant and dosing are appropriate for this patient?

A delicate balance exists between preventing morbidity and mortality from venous thromboembolism (VTE) and preventing associated bleeding complications in older patients. While older age is associated with...

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