Coagulation and anticoagulation

Anticoagulation therapy is common in the elderly. It is used in thrombotic disease for the secondary prevention of myocardial ischaemia (MI), thrombotic stroke and transient ischaemic attacks. It is also used in the acute treatment of MI, intermittent claudication, cardiac valve disease, atrial fibrilliation, deep vein thrombosis (DVT) and pulmonary embolism. GPs commonly use aspirin, clopidogrel, heparin and warfarin or sinthrome, but there are now a number of new oral anticoagulants available and NICE is currently appraising many of them. These drugs exploit advances in the knowledge of coagulation and fibrinolytic physiology. Patients may also present with bleeding disorders that