19. Hemostasis and Aging

  1. Hussain I. Saba MD, PhD Professor of Medicine; Director of Hematology/Hemophilia/Hemostasis & Thrombosis Center; Professor Emeritus2 and
  2. Harold R. Roberts MD Emeritus Professor of Medicine and Pathology3
  1. Lodovico Balducci

Published Online: 14 FEB 2014

DOI: 10.1002/9781118833391.ch19

Hemostasis and Thrombosis

Hemostasis and Thrombosis

How to Cite

Balducci, L. (2014) Hemostasis and Aging, in Hemostasis and Thrombosis (eds H. I. Saba and H. R. Roberts), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118833391.ch19

Editor Information

  1. 2

    USF College of Medicine; Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA

  2. 3

    Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA

Author Information

  1. H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA

Publication History

  1. Published Online: 14 FEB 2014
  2. Published Print: 20 APR 2014

ISBN Information

Print ISBN: 9780470670507

Online ISBN: 9781118833391

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Keywords:

  • aging;
  • bleeding;
  • clotting;
  • D-dimer;
  • hemostasis

Summary

Age is a physiologic event that involves a progressive reduction in the functional reserve of multiple organ systems as well as increased prevalence of comorbidity and geriatric syndromes. The outcomes of aging include functional dependence and death. Aging is associated with increased incidence and prevalence of chronic intravascular anticoagulation, due to chronic and progressive inflammation. In the aged, increased concentration of circulating D-dimer, factor VIII, fibrinogen and VWF, and decreased concentration of PAI-1 are harbingers of increased mortality and increased risk of functional dependence and geriatric syndromes. Aging is associated with increased risk of thromboembolic disorders that is only, in part, related to the clotting abnormalities of aging. The centenarian paradox implies that centenarians are at decreased risk of thromboembolic events despite increased concentration of clotting factors in the circulation. The explanation of this paradox is wanted.

With the advent of replacement therapy, patients with hemophilia have achieved an almost normal life expectancy (despite a drop in life expectancy between 1979 and 1989 due to HIV). Elderly patients with hemophilia appear to have increased prevalence of comorbid conditions. In addition to those due to HIV and hepatitis C, these include those related to chronic arthropathy and join replacement.