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ARTICLE |

Aging and Heparin-Related Bleeding

Norman R. C. Campbell, MD; Russell D. Hull, MBBS; Rollin Brant, PhD; David B. Hogan, MD; Graham F. Pineo, MD; Gary E. Raskob, MSc
Arch Intern Med. 1996;156(8):857-860. doi:10.1001/archinte.1996.00440080047006.
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Background:  Many studies have suggested that elderly patients are at increased risk of bleeding during heparin therapy.

Objective:  To establish whether the risk of bleeding in the elderly results from concomitant risk factors or is associated with the aging process itself.

Methods:  One hundred ninety-nine patients who presented with proximal deep vein thrombosis were treated with a standard intravenous heparin protocol in a doubleblind, randomized, prospective study. Bleeding complications were monitored. Activated partial thromboplastin times and heparin levels were assessed 4 to 6 hours after a standard intravenous heparin bolus and infusion. Heparin doses and heparin levels were also assessed after stable therapeutic heparin infusion rates were established.

Results:  There was an increase in total and major bleeding complications with aging (P<.05) that was not accounted for by standard risk factors for bleeding. Aging was associated with an increase in heparin levels (r=.239, P=.003) and a tendency for an increase in activated partial thromboplastin time (r=.134, P=.07) after standard heparin doses. Aging was also associated with lower heparin dose requirements (r= /p=m-/.267, P=.003) after therapeutic activated partial thromboplastin times were achieved.

Conclusion:  Aging is a risk for heparin-related bleeding that may be explicable by age-related changes in the pharmacologic characteristics of heparin.(Arch Intern Med. 1996;156:857-860)

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