Therapeutic catch 22 - Warfarin use in the elderly

The use of warfarin in the elderly, particularly for stroke prevention in chronic atrial fibrillation, is steadily increasing. Yet under use is still common. While the benefits of warfarin are greatest in the elderly, so are the risk of adverse outcomes and the difficulties of anticoagulant management. Health systems, including community pharmacy services, need to improve to counter this therapeutic dilemma, as warfarin is the only available oral anticoagulant for the prevention of thombosis associated with a wide range of conditions predisposing to thrombosis, including atrial fibrillation, venous thromboembolism heart valve replacement and ' haematological abnormalities. New oral antithrombotics may soon emerge for the management of one or more of these conditions in suitable candidates, but it will be some time before they can be used in the broad range of conditions, patient populations and antithrombotic combinations in which warfarin is currently used.