Venous thromboembolism in the elderly: A narrative review

Persons aged ≥65 years not only account for over 60% of venous thromboembolism (VTE) events, they have also a higher mortality and VTE-related morbidity than younger patients, including anticoagulation-related bleeding and the postthrombotic syndrome. However, only few studies have focused specifically on VTE in older persons and practice guidelines commonly extrapolate study results from younger healthier patients to the multimorbid elderly. Evidence suggests that the clinical presentation is more subtle in the elderly with VTE and that commonly used diagnostic modalities, including clinical prediction rules, D-dimer tests, and planar ventilation-perfusion scans are less specific and efficient in older persons. Moreover, because preventive and therapeutic anticoagulation trials often exclude elderly multimorbid patients who have an increased risk of bleeding, the optimal prophylactic approach in medical inpatients and the best therapeutic anticoagulation strategy in patients with confirmed VTE are uncertain in such patients. In this narrative review, we summarize the evidence on the risk, prevention, diagnosis, treatment, and prognosis of VTE in older patients. We also propose a research agenda to increase the evidence basis on VTE in older patients to optimize their quality of care. Given the fact that the incidence of elderly persons with VTE is likely to rise, future VTE research should attempt to enroll elderly multimorbid patients into pragmatic clinical trials and to increasingly incorporate patient-centered universal outcomes, such as health-related quality of life, functional status, symptom burden, and active life expectancy.