The impact of advanced age on anticoagulant therapy for acute venous thromboembolism

Lafaie, Ludovic; Célarier, Thomas; Monreal, Manuel; Mismetti, Patrick; Delavenne, Xavier; Bertoletti, Laurent

doi:10.1080/17425255.2022.2045273

Cited by 4 publications

(3 citation statements)

References 109 publications

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“…Individualized approaches to anticoagulant therapy may improve outcomes and reduce complications in this population. In these fragile patients, tailored anticoagulant treatment, including the choice of drugs with reduced bleeding risk and fewer pharmacological interactions, should be considered; this step can ensure that these patients are offered the safest and most suitable options for their situation [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

Farid-Zahran,

Méndez-Bailón,

Pedrajas

et al. 2024

JCM

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Introduction: Patients with heart failure (HF) are known to have an increased risk of pulmonary embolism (PE), but there is limited evidence regarding the prognostic implications of HF in patients with acute PE and the relationship between PE prognosis and left ventricular ejection fraction (LVEF). The primary objective of this study was the development of a composite outcome (mortality, major bleeding, and recurrence) within the first 30 days. The secondary objective was to identify the role of LVEF in predicting the development of early complications in patients with both HF and reduced LVEF. Material and Methods: A prospective study was conducted at two tertiary hospitals between January 2012 and December 2022 to assess differences among patients diagnosed with acute PE based on the presence or absence of a history of HF. Cox regression models were employed to assess the impact of HF and reduced LVEF on the composite outcome at 30 days. Results: Out of 1991 patients with acute symptomatic PE, 7.13% had a history of HF. Patients with HF were older and had more comorbidities. The HF group exhibited higher mortality (11.27% vs. 4.33%, p < 0.001) and a higher incidence of major bleeding (9.86% vs. 4.54%, p = 0.005). In the multivariate analysis, HF was an independent risk factor for the development of the composite outcome (HR 1.93; 95% CI 1.35–2.76). Reduced LVEF was independently associated with a higher risk of major bleeding (HR 3.44; 95% CI 1.34–8.81). Conclusion: In patients with acute pulmonary embolism, heart failure is independently associated with a higher risk of early complications. Additionally, heart failure with reduced LVEF is an independent risk factor for major bleeding.

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Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

Farid-Zahran,

Méndez-Bailón,

Pedrajas

et al. 2024

JCM

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“…During the last decade, recommendations concerning VTE management have been progressively modified after the introduction of direct oral anticoagulants (DOACs) 3–6 . Despite the high proportion of older people with an indication of anticoagulation for VTE, they are poorly represented in the major clinical trials evaluating anticoagulants for VTE management 7 . For example, the average age of patients included in the main clinical trials assessing DOACs was under 60 years 8–12 .…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Despite the high proportion of older people with an indication of anticoagulation for VTE, they are poorly represented in the major clinical trials evaluating anticoagulants for VTE management. 7 For example, the average age of patients included in the main clinical trials assessing DOACs was under 60 years. [8][9][10][11][12] This lack of representation of older patients raises a number of questions.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation and venous thromboembolism in patients aged 90 years and older: Data from the RIETE registry

Lafaie,

Poenou,

Hanon

et al. 2023

J American Geriatrics Society

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BackgroundAge is a major risk factor for venous thromboembolism (VTE), yet patients aged ≥90 years are under‐represented in clinical trials of anticoagulant therapy. The objectives were to describe and compare patient clinical characteristics, treatments, and outcomes (VTE recurrence, bleeding, and mortality) during the first 3 months of anticoagulation between VTE patients aged ≥90 years and those aged <90 years.MethodsWe analyzed data from the Registro Informatizado Enfermedad TromboEmbὀlica (RIETE), an ongoing global observational registry of patients with objectively confirmed acute VTE.ResultsFrom January 2001 to October 2022, 96,701 patients were registered in RIETE, of whom 3262 (3.4%) were aged ≥90 years. Patients aged ≥90 years were less likely to be men, and to have experienced cancer or recent surgery, but more likely to manifest immobility, chronic heart failure, anemia, renal insufficiency, or dementia than those aged <90 years. Most (99.6%) patients aged ≥90 years were receiving anticoagulant therapy. During the first 3 months, 26 patients aged ≥90 years developed VTE recurrences, 116 experienced major bleeding, and 564 died. Among patients initially presenting with pulmonary embolism (PE), deaths due to PE exceeded those due to fatal bleeding (76 vs. 19). Among those initially presenting with isolated deep‐vein thrombosis (DVT), it was the reverse (2 vs. 11 deaths).ConclusionsIn patients aged ≥90 years, the difference in the outcome of anticoagulant treatment depending on the initial presentation of VTE could suggest a need for different management approaches. Clinical trials evaluating the optimal duration of anticoagulation according to initial VTE presentation are warranted to limit excess deaths in this particular population.

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Management of cancer-associated thromboembolism in vulnerable population

Laporte,

Benhamou,

Bertoletti

et al. 2024

Archives of Cardiovascular Diseases

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The impact of advanced age on anticoagulant therapy for acute venous thromboembolism

Cited by 4 publications

References 109 publications

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes

Anticoagulation and venous thromboembolism in patients aged 90 years and older: Data from the RIETE registry

Management of cancer-associated thromboembolism in vulnerable population

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