Long-term use of antithrombotic agents in the elderly, particularly in patients with atrial fi brillation, has been a subject of constant debate. Evidence shows long-term antithrombolisation outweighs the risks of bleeding yet such agents are withheld regularly during perioperative periods. Dr Abhay Vaidya and Professor Romesh Gupta discuss how low molecular weight heparin can help prevent thromboembolism and subsequent complications.