Frailty and venous thromboembolism in older adults: Biological links and translational opportunities for risk stratification (narrative review).

INTRODUCTION

Frailty is a geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to stressors. Frailty overlaps with risk factors for deep vein thrombosis (DVT) and venous thromboembolism (VTE), yet it remains underrecognized in thrombotic risk stratification.

OBJECTIVE

To synthesize evidence linking frailty to DVT and VTE in older adults and to discuss translational approaches for incorporating frailty into risk stratification and diagnostic pathways.

METHODS

This narrative review synthesized epidemiological, mechanistic, and translational evidence on the relationship between frailty and thrombotic disease. It critically appraised established frailty assessment tools alongside emerging approaches, including electronic frailty indices and artificial intelligence (AI).

RESULTS

Available evidence supports links between frailty and all components of Virchow's triad. Studies indicate that frail older adults have a higher risk of incident VTE than robust peers, with the strongest estimates exceeding a twofold increase. Frailty is further associated with adverse outcomes after VTE or pulmonary embolism, including higher mortality. Electronic frailty indices offer potential for clinical implementation.

CONCLUSION

Frailty is a relevant marker of thrombotic vulnerability in older adults. Its incorporation into risk models and diagnostic frameworks may improve identification and support prevention and management strategies. However, prospective validation remains necessary before clinical use.