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One of the most fraught choices clinicians make is deciding which older patients should receive anticoagulant therapy. Risk of thrombosis and bleeding both increase with age, and these risks must be balanced with the burdens of anticoagulant monitoring, cost, adherence, and polypharmacy.1 Studies evaluating the net benefit of anticoagulation therapy often exclude the oldest and sickest patients. Consequently, physicians caring for older adults with complex medical conditions instead must rely on extrapolated data and clinical experience; surveys show that patient age acts as a significant deterrent to the use of anticoagulation regardless of other risk factors.2
Parks AL, Covinsky KE. Anticoagulation in the Very Old. JAMA Intern Med. 2016;176(8):1184. doi:10.1001/jamainternmed.2016.3065