Outcomes beyond the Third Month of Anticoagulation in Patients Aged >75 Years with a First Episode of Unprovoked Venous Thromboembolism

  1. Iñurrieta, Amaia 5
  2. Pedrajas, José 5
  3. Núñez, Manuel 1
  4. López-Jiménez, Luciano 2
  5. Velo-García, Alba 1
  6. García, Juan 1
  7. Lecumberri, Ramón 4
  8. Jiménez, David 6
  9. Pons, Isaac 7
  10. Monreal, Manuel 3
  1. 1 Complexo Hospitalario Universitario de Pontevedra
    info

    Complexo Hospitalario Universitario de Pontevedra

    Pontevedra, España

    ROR https://ror.org/016cxc226

  2. 2 Hospital Universitario Reina Sofia
    info

    Hospital Universitario Reina Sofia

    Córdoba, España

    ROR https://ror.org/02vtd2q19

  3. 3 Universidad Católica San Antonio
    info

    Universidad Católica San Antonio

    Murcia, España

    ROR https://ror.org/05b1rsv17

  4. 4 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

  5. 5 Hospital Clínico San Carlos de Madrid
    info

    Hospital Clínico San Carlos de Madrid

    Madrid, España

    ROR https://ror.org/04d0ybj29

  6. 6 Hospital Ramón y Cajal
    info

    Hospital Ramón y Cajal

    Madrid, España

    ROR https://ror.org/050eq1942

  7. 7 Department of Internal Medicine, Hospital de Igualada, Barcelona, Spain
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Revue:
TH Open

ISSN: 2512-9465,  2567-3459

Année de publication: 2018

Volumen: 2

Número: 4

Pages: e428-e436

Type: Article

DOI: 10.1055/S-0038-1676359 GOOGLE SCHOLAR lock_openAccès ouvert editor

D'autres publications dans: TH Open

Objectifs de Développement Durable

Résumé

Background The ideal duration of anticoagulant therapy in elderly patients with unprovoked venous thromboembolism (VTE) has not been consistently evaluated. Methods We used the RIETE ( R egistro I nformatizado E nfermedad T rombo E mbólica) registry to compare the rate and severity of pulmonary embolism (PE) recurrences versus major bleeding beyond the third month of anticoagulation in patients >75 years with a first episode of unprovoked VTE. Results As of September 2017, 7,830 patients were recruited: 5,058 (65%) presented with PE and 2,772 with proximal deep vein thrombosis (DVT). During anticoagulant therapy beyond the third month (median, 113 days), 44 patients developed PE recurrences, 36 developed DVT recurrences, 101 had major bleeding, and 241 died (3 died of recurrent PE and 19 of bleeding). The rate of major bleeding was twofold higher than the rate of PE recurrences (2.05 [95% confidence interval, CI: 1.68-2.48] vs. 0.90 [95% CI: 0.66-1.19] events per 100 patient-years) and the rate of fatal bleeding exceeded the rate of fatal PE events (0.38 [95% CI: 0.24-0.58] vs. 0.06 [95% CI: 0.02-0.16] deaths per 100 patient-years). On multivariable analysis, patients who had bled during the first 3 months (hazard ratio [HR]: 4.32; 95% CI: 1.58-11.8) or with anemia at baseline (HR: 1.87; 95% CI: 1.24-2.81) were at increased risk for bleeding beyond the third month. Patients initially presenting with PE were at increased risk for PE recurrences (HR: 3.60; 95% CI: 1.28-10.1)...