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Pulmonary thromboembolism 

Pulmonary thromboembolism
Chapter:
Pulmonary thromboembolism
Author(s):

Simone Wärntges

, Katrin Schäfer

, and Stavros V. Konstantinides

DOI:
10.1093/med/9780198701590.003.0100
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date: 25 August 2019

Venous thromboembolism (VTE) is the third most frequent acute cardiovascular syndrome; its annual incidence may reach 1200 cases per 100,000 population aged ≥80 years. Besides age-related increases in predisposing conditions, the ageing process itself shifts the balance between pro and anticoagulant pathways towards a propensity to thrombosis. Evaluation of symptoms and clinical signs of suspected VTE in older adults should take into account ‘physiologic’ age-related cardiopulmonary changes. Using age-adjusted (in patients older than 50 years) D-dimer cut-off levels in combination with low or intermediate clinical probability increases the number of patients in whom PE can reliably be excluded without imaging tests. Age is a key determinant of the bleeding risk under fibrinolytic and anticoagulation treatment. Overall, the new oral anticoagulants are effective and safe in older adults; however, age-related changes in renal and other organ function and drug pharmacokinetics mandate regular monitoring and possible dose adjustments.

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