Abstract
Elderly or fragile patients have a high risk of atrial fibrillation, a high risk of systemic embolism, as well as a high risk of venous thromboembolism. They are therefore often candidates for long-term anticoagulation medication.
Fragile patients are characterized by reduced body weight, limited renal function, and multiple comorbidities (associated with many co-medications). Direct oral anticoagulants (DOAC, resp. non-vitamin K antagonist oral anticoagulants, NOAC) registered in the Czech Republic - dabigatran, rivaroxaban, apixaban and edoxaban - are good alternatives to the warfarin in many indications.
Their great advantage is that they do not need to be regularly monitored on a laboratory basis and are considered to be safer, especially due to the significant reduction of the risk of intracranial haemorrhage. Each drug in the group of direct oral anticoagulants has some specificity resulting from pharmacological properties or the results of registration studies, so it is possible to individually determine an optimal anticoagulation strategy.
Consideration of benefit and risk is often complicated in elderly patients, but this should be done repeatedly during the therapy to maintain the safety of medication.