Educational Level, Anticoagulation Quality, and Clinical Outcomes in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study

Abstract

Whether the level of education is associated with anticoagulation quality and clinical outcomes in patients with acute venous thromboembolism (VTE) is uncertain. We thus aimed to investigate the association between educational level and anticoagulation quality and clinical outcomes in elderly patients with acute VTE. We studied 817 patients aged ≥65 years with acute VTE from a Swiss prospective multicenter cohort study (09/2009-12/2013). We defined three educational levels: 1) less than high school, 2) high school, and 3) post-secondary degree. The primary outcome was the anticoagulation quality, expressed as the percentage of time spent in the therapeutic INR range (TTR). Secondary outcomes were the time to a first recurrent VTE and major bleeding. We adjusted for potential confounders and periods of anticoagulation. Overall, 56% of patients had less than high school, 25% a high school degree, and 18% a post-secondary degree. The mean percentage of TTR was similar across educational levels (less than high school, 61%; high school, 64%; and post-secondary, 63%; P = 0.36). Within three years of follow-up, patients with less than high school, high school, and a post-secondary degree had a cumulative incidence of recurrent VTE of 14.2%, 12.9%, and 16.4%, and a cumulative incidence of major bleeding of 13.3%, 15.1%, and 15.4%, respectively. After adjustment, educational level was neither associated with anticoagulation quality nor with recurrent VTE or major bleeding. In elderly patients with VTE, we did not find an association between educational level and anticoagulation quality or clinical outcomes.

Long‐term risk of recurrent venous thromboembolism among patients receiving extended oral anticoagulant therapy for first unprovoked venous thromboembolism: A systematic review and meta‐analysis

“…Of the 26 included studies, 12,26–49 14 were RCTs and 12 were prospective cohort studies with a total of 15 603 patients with a first unprovoked or weakly provoked VTE who, after having completed at least 3 months of initial anticoagulant treatment, received extended anticoagulation (Table 1). The duration of initial anticoagulant treatment was exclusively 3 months in 12 studies (Table 1).…”

Comparison of Warfarin use in terms of efficacy and safety in two different polyclinics

“…play roles in reaching the effective TTR levels. It has been demonstrated that the educational level of patients play roles in the efficacy and safety of warfarin ( 23 - 26 ). In the present study, nearly half of the patients were primary school-graduates, and no significant differences were detected between the groups.…”

Eficácia, segurança e preditores de desfechos clínicos dos antagonistas da vitamina K em pacientes com fibrilação atrial valvar e não valvar

“…Entretando, o nível de escolaridade menor não esteve associado com a ocorrência dos desfechos clínicos. Estes resultados são semelhantes ao observado por Hofmann e colaboradores que encontraram uma incidência cumulativa de 3 anos de TEV recorrente e sangramento maior, sem diferença entre as três categorias educacionais nos pacientes em uso de anticoagulantes 112 .…”