Comparison of Presentation, Treatment, and Outcomes of Venous Thromboembolism in Long-Term Immobile Patients Based on Age
Por:
Weinberg I, Elgendy IY, Dicks AB, Marchena P, Malý R, Francisco I, Pedrajas JM, Font C, Hernández-Blasco L and Monreal M
Publicada:
1 jun 2023
Ahead of Print:
1 feb 2023
Categoría:
Internal medicine
Resumen:
BackgroundChronic immobility is prevalent, especially as people age. However, little is known about venous thromboembolism (VTE) outcomes in this population.ObjectiveTo compare the presentation, treatment, and outcomes in chronically immobile (>8 weeks) patients older vs. younger than 75 who presented with VTE.DesignAn observational international registry of patients with VTE.ParticipantsPatients with acute VTE from the "Registro Informatizado Enfermedad TromboEmbolica" (RIETE) registry who were chronically immobile.Main MeasuresBaseline characteristics, presenting signs and symptoms, treatment and outcomes including major bleeding, recurrent VTE, and mortality.Key ResultsAmong 4612 immobile patients (mean age 75.7 years, 34% male), 2127 (46%) presented with pulmonary embolism (PE). Patients >75 years presented more often with dyspnea (44% vs. 38%) or altered mental status (23% vs. 8.1%) and less often with chest pain (13% vs. 18%). The median duration of anticoagulation was shorter in older compared with younger patients [126 vs. 169 days]. During the first 90 days of anticoagulation, major bleeding (4.0% vs. 2.2%), PE-related death (2.5% vs. 1.1%), and bleeding-related death (0.78% vs. 0.26%) occurred more frequently among older patients. In 3550 patients who received anticoagulation beyond 90 days, older patients had more major bleeding [4.23 vs. 2.21 events per 100 patient years]. After anticoagulation discontinuation, recurrent VTE and major bleeding occurred in 11.8 and 9.25 and 1.49 and 0.69 events per 100 patient years, respectively, both in similar rates in both groups. In multivariable analysis, after stopping anticoagulation, VTE recurrence was inversely associated with long-term facility residence [OR 0.51 (0.28-0.92)], anemia [OR 0.63 (0.42-0.95)], and anticoagulation duration < 90 days [OR 0.38 (0.27-0.54)].ConclusionsChronically immobilized patients older than 75 years presenting with VTE experience a high rate of adverse events including major bleeding and recurrent VTE. When considering treatment beyond 90 days, we should account for bleeding, recurrence risk, and associated mortality.
Filiaciones:
Weinberg I:
Vascular Medicine, Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, GRB-852G, Boston, MA, 02114, USA.
Elgendy IY:
Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
Dicks AB:
Department of Vascular Surgery, Prisma Health/USC School of Medicine Greenville, Greenville, SC, USA
Marchena P:
Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
Malý R:
Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
Francisco I:
Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
Pedrajas JM:
Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
Font C:
Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
Hernández-Blasco L:
Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, UMH, Alicante, Spain
Monreal M:
Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
Green Submitted, Bronze
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