Abstract
Given the aging population, the burden of age-dependent diseases is growing. Despite
this, elderly patients are often underrepresented in clinical trials and little data
are available on current anticoagulant management and outcomes in this unique population,
especially those aged 90 years or older. There is uncertainty, and a fear of “doing
harm,” that often leads to de-prescription of antithrombotic agents in nonagenarian
patients. Decision-making concerning the use of anticoagulant treatment needs to balance
the risk of thrombotic events against the risk of major bleeding, especially intracranial
hemorrhage. In this perspective, the development of direct oral anticoagulants (DOACs),
acting as direct and selective inhibitors of a specific step or enzyme of the coagulation
cascade, has dramatically changed oral anticoagulant treatment. In fact, given the
lower incidence of intracranial hemorrhage, the favorable overall efficacy and safety,
and the lack of routine monitoring, DOACs are the currently recommended anticoagulant
agents for the treatment of both atrial fibrillation and venous thromboembolism even
in very elderly patients. However, given the limited data available on the management
of anticoagulation in nonagenarians, a few unanswered questions remain. In this review,
we focused on recent evidence for anticoagulant treatment in atrial fibrillation and
venous thromboembolism along with management of anticoagulation-related bleeding in
nonagenarians.
Keywords
anticoagulants - atrial fibrillation - nonagenarians - oldest age - venous thromboembolism
