Thromboprophylaxis in elderly patients with frailty syndrome

James Douketis, MD, is a professor of medicine and the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University.

How to prevent thrombosis in an elderly patient with frailty syndrome in the intensive care unit (ICU)?

That’s the other side of the coin. Often you may get a patient who is not overweight but very underweight. They could weigh ≤50 kg. Once again, we don’t have a lot of data for patients like that. Sometimes what we will do is that we will reduce the dose of the anticoagulant by 50%, for example, to account for their lower body weight.

The other part is that we need to be careful in these elderly patients—if they’re often in the hospital for a lengthy period of time, 1 to 2 weeks—that we don’t overprescribe the prophylactic anticoagulant, which is usually a heparin. I’ve seen patients [in whom] we forget to stop it and they develop bleeding complications. One has to be mindful of their body weight to reduce the dose and also to recognize that if they’re in the hospital for a longer period of time, we want to limit the amount of prophylaxis they receive to the acute illness period.