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Consideration of Anticoagulation: Surgical Care for the Elderly in Current Geriatrics Reports

  • Jared R. GallaherEmail author
  • Joanna Grudziak
  • Martin A. Schreiber
Surgical Care (F Luchette and R Gonzalez, Section Editors)
  • 7 Downloads
Part of the following topical collections:
  1. Topical Collection on Surgical Care

Abstract

Introduction

The geriatric population in the USA is growing at a dramatic rate. As this segment of the population increases in number, surgical providers will increasingly treat and evaluate patients with age-specific needs that affect surgical or trauma management. Consequently, surgeons should be familiar with trends in prescribing oral anticoagulants (OACs), their association with outcomes, and the guidelines for reversing and prescribing these medications.

Results

Warfarin was the only oral anticoagulant available in the USA until 2010 when non-vitamin K antagonist oral anticoagulants (NOACs) were introduced to the market. Since then, they have rapidly gained a majority of the US market share. The implications of NOAC use on bleeding complications such as in traumatic brain injury (TBI) are unclear, but evidence suggests that NOACs may be safer than warfarin. Guidelines for anticoagulation reversal in life-threatening bleeding associated with warfarin are well established, but optimal utilization is evolving for most NOAC agents.

Conclusion

The use of anticoagulation therapy has changed dramatically over the last decade. These changes are multifactorial and include the increasing prevalence of OAC use, and the introduction of NOACs. Consequently, challenges associated with managing OAC in the elderly will only become more complicated over time. Surgical providers need to be aware of these changes and update their practice on the shifting epidemiology of this population, evolving guidelines, and new reversal agents.

Keywords

Geriatric anticoagulation Elderly anticoagulation Anticoagulation and surgery Oral anticoagulation trends Anticoagulation and trauma 

Notes

Compliance with Ethical Standards

Conflict of Interest

Jared R. Gallaher, Joanna Grudziak, and Martin A. Schreiber each declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jared R. Gallaher
    • 1
    Email author
  • Joanna Grudziak
    • 2
  • Martin A. Schreiber
    • 1
  1. 1.Department of SurgeryOregon Health & Science UniversityPortlandUSA
  2. 2.Department of SurgeryUniversity of North Carolina School of MedicineChapel HillUSA

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