Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 591

The elderly are more prone to arterial as well as venous thromboembolism, and thrombotic disease is the commonest cause of hospital admission, disability, and death in patients over 50 in the developed world.

The incidence of a first acute VTE, defined as DVT and/or PE, rises exponentially with age, ranging from approximately 1 per 10,000 subjects age 25–30 to a rate of nearly 8 per 1000 in the population 85 and older.¹⁸ Overall, >60% of all VTE events occur in people ≥65.¹⁹

Several factors could explain the higher incidence of thromboembolism in the elderly:

1 Increased prevalence in the elderly of cancer, stroke, heart failure, recent myocardial infarction, severe infection, diabetes mellitus, obesity, chronic obstructive pulmonary disease, inflammatory bowel disease, frailty, hospitalization, nursing home residence, immobilization, and history of VTE, all of which are considered risk factors for VTE.¹ Elderly patients are more likely to have cancer‐related VTE than younger patients.

2 Atrial fibrillation (AF) is the most common arrhythmia in our daily clinical practice, affecting 4.5 million people in Europe and approximately 33.5 million people globally.²⁰ Estimates suggest a significant increase in AF incidence with age from 4.1/1000 under age 75 to 26.3/1000 in people older than 75.²¹ In the same way, its prevalence rises from 0.1% in people under 55 to 9% of those older than 80. Due to the increase in life expectancy, the number of elderly people over 80 with NVAF will increase fourfold by 2050; therefore, this group will represent over 50% of total patients with this arrhythmia, and the stroke risk will increase 25–36% in elderly individuals between 80 and 89.²¹

3 Age‐related endothelial dysfunction and alterations in platelet function may contribute to the increased risk of VTE in the elderly.²² The levels of several plasma components (fibrinogen, factor VII, factor VIII, D‐dimer, and homocysteine) increase with age, although it is unclear whether this has a clinically meaningful impact on the risk of VTE.²²

4 Hyperglycaemia is associated with enhanced thrombin formation in patients with diabetes or cardiovascular disease, which are more common in older people, increasing the risk of thromboembolic events.²³