[Coagulation management in geriatric surgery].

BACKGROUND: Elderly patients often suffer from cardiovascular diseases and are treated with anticoagulation medications, which must be taken into consideration when planning elective surgery.
OBJECTIVE: The etiology, diagnostic work-up and clinical management of selected inherited and acquired hemophilic and thrombophilic coagulation disorders are described.
METHODS: Data from clinical studies, current guidelines and expert opinions are discussed.
RESULTS: Beside inherited hemophilic coagulation defects, elderly patients very frequently show an acquired bleeding tendency caused by the intake of analgesic drugs or long-term medication due to cardiovascular diseases. In rare cases, elderly patients can develop acquired hemophilia caused by autoantibodies to coagulation factors resulting in a severe bleeding disorder. Moreover, elderly patients have an increased risk to develop venous or arterial thrombotic events. Prior to surgery a relevant bleeding tendency should be excluded by the combination of medical history, clinical investigation and screening of laboratory parameters. If laboratory parameters are outside the normal range, e.g. a prolonged activated partial thromboplastin time (aPTT), the reasons must be clarified prior to an elective surgery.
CONCLUSION: The clinical management of elderly patients under anticoagulation treatment should start early and must also cover the post-surgery period. When planning treatment for patients at risk, a physician qualified in clinical hemostaseology should be consulted. For the management of thrombosis prophylaxis, the implementation of clinical guidelines is a valuable measure.