Jeffrey Schiff, MD, FRCP(C), Instructor, Division of Medicine, University of Toronto; Division of Nephrology and Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON.

Due to the excellent outcomes of renal transplantation, there is an increasing number of people surviving with, or receiving a transplant, at an older age. While the transplant centre usually manages the immunosuppression and renal problems, these individuals also require primary care. This article will review the common health issues that primary care physicians encounter routinely among these patients. Common problems include managing cardiovascular risk factors, screening for malignancy, vaccinations, treatment of uncomplicated infections, and bone disease. Important drug interactions will be reviewed. Communication between the primary care physician and the transplant centre will also improve care of these patients.
Key words: renal transplantation, primary care, cardiovascular disease, drug interactions, chronic kidney disease.

Andrew Liu, BSc Hon, BScPhm, RPh, Clinical Pharmacist, Thrombosis Service, Toronto East General Hospital, Toronto, ON.
Carmine Stumpo, BScPhm, PharmD, RPh, Director, Pharmacy and Emergency Services, Toronto East General Hospital, Toronto, ON.

Warfarin-drug interactions are often encountered in the care of older adults. Interactions may be classified as pharmacokinetic, resulting in changes in serum warfarin concentrations, or pharmacodynamic, resulting in changes in hemostasis or platelet function. Knowledge of these mechanisms of warfarin-drug interactions may help identify warfarin interactions, facilitate prescribing decisions, and assist with appropriate monitoring.
Key words: warfarin, drug interactions, anticoagulants, cytochrome P-450 enzyme system, older adults.

Anne Grand'Maison, MD, FRCPC, Hematologist, Research Fellow, Thromboembolism Department, Sunnybrook and Women's College Health Sciences Centre; University of Toronto, Toronto, ON.
William Geerts, MD, FRCPC, Consultant in Clinical Thromboembolism, Sunnybrook and Women's College Health Sciences Centre; University of Toronto, Toronto, ON.

The elderly population is at risk of arterial and venous thromboembolic diseases. Traditional anticoagulants have demonstrated their benefits for prevention and treatment of these conditions and are accepted as standard practice. Despite this evidence, anticoagulants are still underused in older people. Practitioners often hesitate to consider anticoagulation in the elderly because of comorbidities, potential drug interactions and increased risk of bleeding. Careful assessment of bleeding risk and close monitoring of anticoagulant level are essential strategies to optimize the use of anticoagulants in the elderly. Many recently developed antithrombotics that have completed late stage of testing are presented in this review, although further studies are needed to determine their exact role, particularly in the elderly.
Key words: factor Xa inhibitor, antithrombin, renal insufficiency, drug interactions, bleeding risk index.