Use of low-molecular-weight heparins and new anticoagulants in elderly patients with renal impairment.


:Elderly people with renal impairment are at high risk for venous thromboembolism (VTE) and acute coronary syndromes (ACS); however, they are also at increased risk for bleeding complications. Evidence-based data for the management of anticoagulation in elderly patients with severe renal impairment, in particular, are limited. These patients are frequently excluded from randomized clinical trials evaluating anticoagulants, confounding clinical decision making. Low-molecular-weight heparins (LMWHs), such as enoxaparin sodium and dalteparin sodium, provide a predictable anticoagulant effect across almost all patient populations; however, because they are primarily eliminated through the kidneys, elderly patients with moderate or severe renal impairment are potentially at risk for LMWH accumulation. Clinical evidence suggests that treatment with full-dose enoxaparin sodium could increase the risk for bleeding in elderly patients with severe renal impairment; however, this risk is ameliorated with approved dose adjustments. Dalteparin sodium has been evaluated in small studies within this population but no strategy for reduced dosing has been developed. There are limited clinical data on the use of fondaparinux sodium and, in particular, the new anticoagulants, such as dabigatran etexilate and rivaroxaban, in elderly patients with renal impairment. Evidence suggests that the clearance of fondaparinux sodium is mildly reduced in elderly patients, and more substantially reduced in patients with severe renal impairment; a dose reduction has recently been approved in Europe. Age and renal function appear to affect the exposure of dabigatran etexilate. A dose reduction is recommended in the elderly and in those with moderate renal function, but dabigatran etexilate is contraindicated in severe renal impairment. Rivaroxaban has been associated with increased exposure and pharmacodynamic effects in the elderly and those with renal impairment; at present there is no facility for dose reduction. Monitoring anticoagulant activity may help improve the safety profile of anticoagulants in elderly patients with renal impairment, particularly when approved dose reductions are unavailable. However, unlike the LMWHs, clinical surveillance of the new anticoagulants is challenging. In conclusion, extra care should be taken when anticoagulants are administered to elderly patients with renal impairment. Additional data are needed, particularly for the new anticoagulants, in order to guide the prevention and treatment of VTE and ACS, and to ensure the optimal safety profile in older patients with renal impairment.


Drugs Aging


Drugs & aging


Samama MM




Has Abstract


2011-03-01 00:00:00














  • Improvement in Renal Function and Reduction in Serum Uric Acid with Intensive Statin Therapy in Older Patients: A Post Hoc Analysis of the SAGE Trial.

    abstract:BACKGROUND:Improvement in renal function and decreases in serum uric acid (SUA) have been reported following prolonged high-intensity statin (HMG-CoA reductase inhibitor) therapy. This post hoc analysis of the SAGE trial examined the effect of intensive versus less intensive statin therapy on renal function, safety, an...

    journal_title:Drugs & aging

    pub_type: 杂志文章,随机对照试验


    authors: Deedwania PC,Stone PH,Fayyad RS,Laskey RE,Wilson DJ

    更新日期:2015-12-01 00:00:00

  • The quality of quality measures: HEDIS® quality measures for medication management in the elderly and outcomes associated with new exposure.

    abstract:BACKGROUND:Clinical validation studies of the Healthcare Effectiveness Data and Information Set (HEDIS®) measures of inappropriate prescribing in the elderly are limited. OBJECTIVES:The objective of this study was to examine associations of new exposure to high-risk medication in the elderly (HRME) and drug-disease in...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Pugh MJ,Marcum ZA,Copeland LA,Mortensen EM,Zeber JE,Noël PH,Berlowitz DR,Downs JR,Good CB,Alvarez C,Amuan ME,Hanlon JT

    更新日期:2013-08-01 00:00:00

  • Antidepressants and falls in the elderly.

    abstract::Antidepressants have long been recognized as a contributory factor to falls and many studies show an association between antidepressants and falls. There are extensive data for tricyclic antidepressants (TCAs) and related drugs, and for selective serotonin reuptake inhibitors (SSRIs), but few data for other classes of...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Darowski A,Chambers SA,Chambers DJ

    更新日期:2009-01-01 00:00:00

  • Did the introduction of a prospective payment system for nursing home stays reduce the likelihood of pharmacological management of secondary ischaemic stroke?

    abstract:BACKGROUND:Since 1998, a prospective payment system (PPS) for Medicare services provided by nursing homes in the US has been in operation. Concerns have been expressed that the PPS may affect the quality of care delivered to residents. This study evaluates the impact of the PPS on pharmacological secondary ischaemic st...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Lapane KL,Hughes CM

    更新日期:2006-01-01 00:00:00

  • Opioids for the treatment of chronic non-cancer pain in older people.

    abstract::Chronic pain occurs in 45-85% of the geriatric population and the need to treat chronic pain is growing substantially. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life, with decreased socialization, depression, sleep disturbances, cognitive impairment...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Gianni W,Ceci M,Bustacchini S,Corsonello A,Abbatecola AM,Brancati AM,Assisi A,Scuteri A,Cipriani L,Lattanzio F

    更新日期:2009-12-01 00:00:00

  • Effect of reproductive hormones and selective estrogen receptor modulators on mood during menopause.

    abstract::Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during perimenopause. It has been speculated that sex steroids such as estroge...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Soares CN,Poitras JR,Prouty J

    更新日期:2003-01-01 00:00:00

  • High prevalence of medication non-adherence in a sample of community-dwelling older adults with adult protective services-validated self-neglect.

    abstract:BACKGROUND:Medication non-adherence can exacerbate disease severity, leading to impairments that interfere with self-care activities in older adults, and, ultimately, death. Elder self-neglect is the most common report to Adult Protective Services (APS) across the USA and is a significant risk factor for early mortalit...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Turner A,Hochschild A,Burnett J,Zulfiqar A,Dyer CB

    更新日期:2012-09-01 00:00:00

  • Age-related endothelial dysfunction : potential implications for pharmacotherapy.

    abstract::Aging per se is associated with abnormalities of the vascular wall linked to both structural and functional changes that can take place at the level of the extracellular matrix, the vascular smooth muscle and the endothelium of blood vessels. Endothelial dysfunction is generally defined as a decrease in the capacity o...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Matz RL,Andriantsitohaina R

    更新日期:2003-01-01 00:00:00

  • Calcium sensitising agents in heart failure.

    abstract::Congestive heart failure (CHF) is a common cardiovascular disorder that is characterised, in part, by a decreased cardiac output reserve. Accordingly, there is ongoing interest in the role of positive inotropic agents (e.g. adrenergic agonists and phosphodiesterase type III inhibitors, which mediate their cardiovascul...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Mathew L,Katz SD

    更新日期:1998-03-01 00:00:00

  • Management of secondary hyperparathyroidism in the elderly patient with chronic kidney disease.

    abstract::Patients with chronic kidney disease (CKD) are generally affected by secondary hyperparathyroidism (SHPT). High phosphate, low calcium and vitamin D deficiency represent the classical 'triad' involved into the pathogenesis of SHPT in renal insufficiency, in which downregulation of the parathyroid vitamin D receptor an...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Cozzolino M,Gallieni M,Pasho S,Fallabrino G,Ciceri P,Volpi EM,Olivi L,Brancaccio D

    更新日期:2009-01-01 00:00:00

  • Interventions to Improve Medicines Management for People with Dementia: A Systematic Review.

    abstract:BACKGROUND:The importance of optimising medicines management for people with dementia has been emphasised through research and policy. However, evidence is currently lacking regarding how to achieve this in this patient population. OBJECTIVE:The aim was to assess the effectiveness of medicines management interventions...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: McGrattan M,Ryan C,Barry HE,Hughes CM

    更新日期:2017-12-01 00:00:00

  • Treatment of Seizures in Older Patients with Dementia.

    abstract::The numbers of patients with dementia and patients with epilepsy are increasing in the global population. In fact, these two conditions are related, and it is estimated that at least 5-10% of seizures or epilepsy in older individuals (aged > 60 years) are caused by a neurodegenerative dementia. In the vast majority, o...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Cretin B

    更新日期:2020-12-14 00:00:00

  • Getting better, getting well: understanding and managing partial and non-response to pharmacological treatment of non-psychotic major depression in old age.

    abstract::In general, the pharmacological treatment of non-psychotic major depressive disorder in old age is only partially successful, with only approximately 50% of older depressed adults improving with initial antidepressant monotherapy. Many factors may predict a more difficult-to-treat depression, including coexisting anxi...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Driscoll HC,Karp JF,Dew MA,Reynolds CF 3rd

    更新日期:2007-01-01 00:00:00

  • Genetic factors in osteoporosis. What are the implications for prevention and treatment?

    abstract::Osteoporosis is a common disease that affects 1 in 3 women. Family and twin studies have demonstrated that there is a strong genetic component to this condition. Potential candidate genes examined for their regulatory effect on bone mass include those for collagen type I, estrogen and vitamin D receptors, and various ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Keen RW,Kelly PJ

    更新日期:1997-11-01 00:00:00

  • Economic evaluation of ropinirole prolonged release for treatment of Parkinson's disease in the Netherlands.

    abstract:BACKGROUND:By using the findings obtained from the PREPARED study, we aimed to estimate the cost effectiveness of ropinirole prolonged release (PR) [Requip-Modutab(®)] in Parkinson's disease (PD) versus ropinirole immediate release (IR). In the PREPARED study, ropinirole PR provided a significantly greater improvement ...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: van Boven JF,Novak A,Driessen MT,Boersma C,Boomsma MM,Postma MJ

    更新日期:2014-03-01 00:00:00

  • Pharmacological approaches to the prevention of restenosis after coronary angioplasty.

    abstract::Restenosis in the months following a successful percutaneous transluminal coronary angioplasty (PTCA) remains the main limitation to this technique for myocardial revascularisation. Despite intensive investigation in this area, no pharmacological therapy has yet been found to be useful in preventing restenosis after c...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Hamon M,Lécluse E,Monassier JP,Grollier G,Potier JC

    更新日期:1998-10-01 00:00:00

  • Use of Antibiotics in Chronic Obstructive Pulmonary Disease: What is Their Current Role in Older Patients?

    abstract::Chronic obstructive pulmonary disease (COPD) has considerable morbidity and mortality in the older adult population. The role of antibiotics in the management of acute exacerbations of COPD (AECOPD) is currently evolving. Despite only mild benefits, most patients with AECOPD in ambulatory settings receive antibiotics ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Al-Hasan MN,Al-Jaghbeer MJ

    更新日期:2020-09-01 00:00:00

  • Optimal remifentanil dosage for intubation without muscle relaxants in elderly patients.

    abstract:BACKGROUND:Remifentanil used in combination with propofol provides adequate conditions for tracheal intubation without muscle relaxants. Delivery of the optimal dose is important to prevent poor intubation conditions and drug-related complications. No previous study has investigated the use of a remifentanil-propofol c...

    journal_title:Drugs & aging

    pub_type: 临床试验,杂志文章


    authors: Goo EK,Oh AY,Cho SJ,Seo KS,Jeon YT

    更新日期:2012-11-01 00:00:00

  • Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study.

    abstract:BACKGROUND:Increased life expectancy is associated with an increased prevalence of chronic diseases and drug consumption. Changes often occur in the medication regimen after hospitalization. The extent and nature of these changes and the adherence of elderly patients have not yet been fully investigated. OBJECTIVE:To ...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Mansur N,Weiss A,Hoffman A,Gruenewald T,Beloosesky Y

    更新日期:2008-01-01 00:00:00

  • Gerontology forum: an update on the literature.

    abstract::New treatments and treatment protocols for diseases affecting the elderly are evolving as we strive to meet the needs of an aging society. To help you keep up to date with the latest advances worldwide on all aspects of drug therapy and patient management, this section of the journal brings you information selected fr...

    journal_title:Drugs & aging




    更新日期:2006-01-01 00:00:00

  • Understanding gender differences in statin use among elderly Medicare beneficiaries: an application of decomposition technique.

    abstract:BACKGROUND:Pharmacotherapy with statins (HMG-CoA reductase inhibitors) is the cornerstone for lipid management in individuals with or at risk of developing cardiovascular diseases. Although the clinical benefits of statins are established for both women and men, there is evidence of a gender difference in their use. Th...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Bhattacharjee S,Findley PA,Sambamoorthi U

    更新日期:2012-12-01 00:00:00

  • Melatonin prolonged release: in the treatment of insomnia in patients aged ≥55 years.

    abstract::Melatonin prolonged release (PR) 2 mg is approved for the treatment of primary insomnia characterized by poor sleep quality in patients aged ≥55 years in the EU and elsewhere. Patients may receive treatment with melatonin PR for up to 13 weeks. Production of endogenous nocturnal melatonin, which helps regulate circadi...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Lyseng-Williamson KA

    更新日期:2012-11-01 00:00:00

  • Population Pharmacokinetic/Pharmacodynamic Modeling of O-Desmethyltramadol in Young and Elderly Healthy Volunteers.

    abstract:BACKGROUND:Age-related changes in the concentration-effect relationship of (+)-O-desmethyl-tramadol [(+)-ODM], tramadol's active metabolite, are not documented in the elderly. OBJECTIVE:The objective of this study was to characterize, in elderly and young subjects, the (+)-ODM pharmacokinetic and pharmacodynamic relat...

    journal_title:Drugs & aging

    pub_type: 杂志文章,随机对照试验


    authors: Robertson SS,Mouksassi MS,Varin F

    更新日期:2019-08-01 00:00:00

  • New atypical antipsychotics. Experience and utility in the elderly.

    abstract::The atypical antipsychotics are a new class of agents with great promise for use in the elderly because of their reduced propensity to cause acute extrapyramidal adverse effects. Treatment of older patients with these agents, however, needs to take into consideration age-related changes in pharmacokinetics and the ris...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Sweet RA,Pollock BG

    更新日期:1998-02-01 00:00:00

  • Epidemiology and optimal management of polymyalgia rheumatica.

    abstract::Polymyalgia rheumatica (PMR) is a disease of unknown aetiology that occurs in elderly patients, predominantly affecting the Caucasian population. The disease has a slightly higher prevalence in women than in men. There is ongoing discussion regarding the relationship between PMR and giant cell arteritis; an increasing...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Labbe P,Hardouin P

    更新日期:1998-08-01 00:00:00

  • International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action.

    abstract::Globally, the number of drug prescriptions is increasing causing more adverse drug events, which is now a significant cause of mortality, morbidity, and disability that has reached epidemic proportions. The risk of adverse drug events is correlated to very old age, multiple co-morbidities, dementia, frailty, and limit...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Mangin D,Bahat G,Golomb BA,Mallery LH,Moorhouse P,Onder G,Petrovic M,Garfinkel D

    更新日期:2018-07-01 00:00:00

  • Treatment of Overactive Bladder in the Elderly Female: The Case for Trospium, Oxybutynin, Fesoterodine and Darifenacin.

    abstract::Overactive bladder (OAB) is a common constellation of lower urinary tract storage symptoms that causes a significant impact on a person's quality of life. The elderly may be disproportionally impacted by these symptoms due to concomitant poor mobility, comorbid conditions such as diabetes and heart failure, and polyph...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: McFerren SC,Gomelsky A

    更新日期:2015-10-01 00:00:00

  • Impact of home patient telemonitoring on use of β-blockers in congestive heart failure.

    abstract:INTRODUCTION:Congestive heart failure (CHF), which typically affects older people, is characterized by high short- and mid-term mortality rates. However, despite accumulating evidence showing that administration of β-blockers (β-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these age...

    journal_title:Drugs & aging

    pub_type: 杂志文章,随机对照试验


    authors: Antonicelli R,Mazzanti I,Abbatecola AM,Parati G

    更新日期:2010-10-01 00:00:00

  • The Evolving Complexity of Treating Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2 (HER2)-Negative Breast Cancer: Special Considerations in Older Breast Cancer Patients-Part I: Early-Stage Disease.

    abstract::The median age for breast cancer diagnosis is 62 years, but a disproportionate number of patients are over the age of 75 years and the majority of those have hormone receptor-positive, human epidermal growth factor receptor-2 (HER2)-negative cancers. This review provides a logical algorithm to guide providers through ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审


    authors: Sammons S,Sedrak MS,Kimmick GG

    更新日期:2020-05-01 00:00:00

  • Use of Medicines that May Exacerbate Heart Failure in Older Adults: Therapeutic Complexity of Multimorbidity.

    abstract:BACKGROUND:Multimorbidity is common in older patients with heart failure (HF), complicating therapeutic management and increasing the risk of harm. OBJECTIVE:This study sought to examine the prevalence of medicines for the treatment of comorbid conditions potentially associated with harm in older people, before and af...

    journal_title:Drugs & aging

    pub_type: 杂志文章


    authors: Caughey GE,Shakib S,Barratt JD,Roughead EE

    更新日期:2019-05-01 00:00:00