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Deep vein thrombosis and pulmonary embolism are a major cause of in-hospital mortality and age is an independent risk factor for thromboembolism, with an incidence for deep vein trombosis of approximately 300 per 100 000 per year in the 65- to 69-year age group, and to >800 per 100 000 per year among patients aged 80 years or more; pulmonary embolism accounts for an increasing proportion (up to 40%) of VTE events in elderly. Mortality from venous thromboembolism is also increased with age. Venous thromboembolism is often underdiagnosed in the elderly population, and routine prophylaxis is often not adequate to level of risk The use of anticoagulant agents in venous thromboembolism prophylaxis and treatment in the elderly is complicated by an increase with age in the presence of multiple risk factors and co-morbidities that may increase the risk of both VTE and bleeding. Risk factors for venous thromboembolism (VTE) can be divided in intrinsic, extrinsic and molecular factors.
| Intrinsic factors | Family history/past history of VTE Advanced age Obesity | Varicose veins Venous insufficiency Thrombophilia | | Extrinsic factors | Pregnancy Estrogen therapy Weakening or paralysis of a lower limb Hospitalisation with or without surgery Immobilisation or restriction of mobility Previous or current malignancy Acute or chronic heart failure | Inflammatory bowel disease Violent effort or muscular trauma Prior central venous catheter or transvenous pacemaker Deterioration of general condition Long-distance travel Chronic oedema of the lower limbs Acute infectious disease Chronic respiratory failure | | Molecular factors | Deficiencies antithrombin antiphospholipid antibody/lupus anticoagulant protein C protein S prothrombin gene mutation methylene tetrahydrofolate reductase mutation | Factor V Leiden mutation Raised factor VIII levels Activated protein C resistance Hyperhomocysteinaemia Raised prothrombin levels Hyperfibrinogenaemia |
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Thromboembolic disease 
