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Anticoagulants are a class of drugs essential for the optimal management of many thromboembolic and vascular disorders that are highly prevalent among older patients. Anticoagulants are unique compared to most pharmacologic agents because even small deviations from “therapeutic levels” place patients at risk for life-threatening complications. While older patients with multimorbidity are particularly susceptible to thrombosis, they also have higher risks of bleeding than the general population. With the approval of direct oral anticoagulants (DOACs) for thrombotic conditions, these agents are being used more frequently than traditional anticoagulants in the older patient due to convenience and lower bleeding risk in the general population. This chapter briefly reviews current anticoagulant therapy and focuses on the newer agents and recommendations for their use in older patients.


Current anticoagulants that are available for use in the United States include unfractionated heparin (UFH), vitamin K antagonists (VKAs), low-molecular-weight heparins (LMWHs), indirect selective factor Xa inhibitor, and the direct thrombin (parental and oral) and factor Xa inhibitors. Tables 44–1 and 44–2 summarize the specific pharmacologic characteristics of these agents.

Table 44–1.Available classes of parenteral anticoagulant therapy.

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