The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology

Méan, Marie; Righini, Marc; Jaeger, Kurt A.; Beer, Jürg H.; Frauchiger, Beat; Osterwalder, Josef Johann; Kucher, Nils; Lämmle, Bernhard; Cornuz, Jacques; Angelillo‐Scherrer, Anne; Rodondi, Nicolas; Limacher, Andreas; Trelle, Sven; Matter, Christian M.; Husmann, Marc; Borggrefe, Martin; Aschwanden, Markus; Egloff, Michaël; Mazzolai, Lucia; Hügli, Olivier; Bounameaux, Henri; Aujesky, Drahomir

doi:10.1007/s11239-013-0875-2

Cited by 66 publications

(124 citation statements)

References 47 publications

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“…with a smaller number of VTE events (n=157) showed that only 35% of venous thrombosis in IBD patient’s occurred in hospitalized patients 21 . This outpatient predominance is not unique to IBD with other studies demonstrating that inpatients account for 18% to 30% of VTE occurring in the general population 22–24 . However the fact that twice the VTE burden in the IBD population occurs in the inpatient setting (compared to non-IBD matched controls) suggests that a larger fraction of VTE may thus be ‘preventable’ in those with IBD.…”

Section: Discussionsupporting

confidence: 43%

Venous Thromboembolism in Patients with Inflammatory Bowel Diseases

Scoville¹,

Konijeti²,

Nguyen³

et al. 2014

Inflammatory Bowel Diseases

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Introduction Inflammatory bowel disease is a well known risk factor for venous thromboembolism (VTE). Existing guidelines for thromboprophylaxis in hospitalized patients do not extend to other clinical scenarios that may also be associated with VTE risk. Our aim was to estimate the fraction of VTE events in IBD patients that could be prevented. Methods A retrospective analysis assessed all IBD patients diagnosed with VTE at a single academic medical center from 2002–2012. Confirmed cases were analyzed for VTE risk factors, inpatient status, the use of DVT prophylaxis, and when applicable the reason for omission of prophylaxis. IBD VTE cases were compared with age- and sex-matched non-IBD VTE controls with regards to risk factors and potential opportunities for VTE prevention. Results There were 204 IBD patients (108 UC, 96 CD) diagnosed with VTE (110 DVT, 66 PE, 27 intra-abdominal thromboses, 1 other). One third of the VTE events occurred in hospitalized patients. Two-third of the medical inpatients and 44% of surgical in-patients who developed VTE did not receive prophylaxis. Importantly, 129 VTE events occurred in outpatients. The proportion of outpatients hospitalized within 4 weeks of developing venous thrombosis was higher in IBD patients than non-IBD controls (33 vs. 15%, p=0.0003). One-third of patients (36%) were experiencing ambulatory disease flares at the time of VTE diagnosis. Conclusions A substantial portion of VTE events in IBD patients occurred in clinical scenarios not routinely recommended for thromboprophylaxis. Further investigation of primary prophylaxis for IBD patients in high risk outpatients may be warranted.

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Section: Discussionsupporting

confidence: 43%

Venous Thromboembolism in Patients with Inflammatory Bowel Diseases

Scoville¹,

Konijeti²,

Nguyen³

et al. 2014

Inflammatory Bowel Diseases

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“…12 A detailed description of the study methods has been published previously. 12 Briefly, consenting consecutive patients aged $65 years with objectively diagnosed, symptomatic DVT or PE were prospectively identified and followed over time. The ethics committee at each participating center approved the study, which followed the Helsinki protocol.…”

Section: Methodsmentioning

confidence: 99%

“…The outcome was the recurrence of symptomatic, objectively confirmed VTE within 12 and 24 months of D-dimer testing, defined as symptomatic new DVT or PE, based on predefined imaging criteria or autopsy as previously described. 12 Three blinded, independent experts adjudicated all recurrences.…”

Section: Org Frommentioning

confidence: 99%

Predicting recurrence after unprovoked venous thromboembolism: prospective validation of the updated Vienna Prediction Model

Tritschler

Méan

Limacher

et al. 2015

Blood

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Key Points• The updated Vienna Prediction Model was developed to identify patients with unprovoked VTE who are at low risk of recurrence.• In elderly patients with unprovoked VTE, the model does not discriminate between patients who develop recurrent VTE and those who do not.The updated Vienna Prediction Model for estimating recurrence risk after an unprovoked venous thromboembolism (VTE) has been developed to identify individuals at low risk for VTE recurrence in whom anticoagulation (AC) therapy may be stopped after 3 months. We externally validated the accuracy of the model to predict recurrent VTE in a prospective multicenter cohort of 156 patients aged ‡65 years with acute symptomatic unprovoked VTE who had received 3 to 12 months of AC. Patients with a predicted 12-month risk within the lowest quartile based on the updated Vienna Prediction Model were classified as low risk.The risk of recurrent VTE did not differ between low-vs higher-risk patients at 12 months (13% vs 10%; P 5 .77) and 24 months (15% vs 17%; P 5 1.0 IntroductionUnprovoked venous thromboembolism (VTE) is associated with a 5% to 27% annual risk of recurrence after discontinuation of anticoagulation (AC), 1-4 and indefinite AC is recommended if the bleeding risk is low to moderate. 5 However, in one-third of patients with unprovoked VTE, the risk of recurrence is so low (,3% per year) that anticoagulant therapy .3 months may not be necessary. 4,6 Several prediction rules were derived to identify patients with unprovoked VTE who have a low recurrence risk. 4,[7][8][9] One is the original Vienna Prediction Model, which was derived in 929 patients (median age, 54 years) with a first unprovoked VTE. 8 Based on 3 parameters, sex, location of VTE (pulmonary embolism [PE]/proximal deep vein thrombosis [DVT] vs distal DVT), and a quantitative D-dimer level determined by enzyme-linked immunosorbent assay (ELISA) at 3 weeks after discontinuation of AC, the risk of recurrent VTE can be estimated. In an external validation study enrolling 904 older patients (median age, 68 years), the model showed a less than optimal calibration, underestimating the observed cumulative recurrence rates at 12 months. 10The updated Vienna Prediction Model is an improved version of the original Vienna Prediction Model and allows prediction of recurrence at several different time points after stopping AC.9 It was developed in a prospective cohort of 553 patients with unprovoked VTE and uses the same clinical parameters (ie, sex, location of VTE, and a quantitative D-dimer level determined by ELISA between 3 weeks and 15 months after discontinuation of AC) to estimate the risk of recurrent VTE up to 60 months, using nomograms or a web-based calculator (www. meduniwien.ac.at/user/georg.heinze/dvpm/). 9 To our knowledge, the updated Vienna Prediction Model has never been externally validated. We aimed to validate the accuracy of the updated Vienna Prediction Model to predict recurrence in elderly patients with unprovoked VTE. Given that elderly patients are at higher risk of...

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“…A full description of the cohort methods, including eligibility criteria, definition of VTE, and follow-up procedures, has been published elsewhere. 17,18 Anticoagulant treatment (i.e., parenteral anticoagulant followed by vitamin K antagonists or parenteral anticoagulation alone) was left to the discretion of the managing hospital and primary care physicians. For this project, we excluded all patients who did not receive oral anticoagulation with vitamin K antagonists within 14 days of the index VTE event.…”

Section: Cohort Samplementioning

confidence: 99%

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

et al. 2014

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BACKGROUND: Polypharmacy, defined as the concomitant use of multiple medications, is very common in the elderly and may trigger drug-drug interactions and increase the risk of falls in patients receiving vitamin K antagonists. OBJECTIVE: To examine whether polypharmacy increases the risk of bleeding in elderly patients who receive vitamin K antagonists for acute venous thromboembolism (VTE). DESIGN: We used a prospective cohort study. PARTICIPANTS: In a multicenter Swiss cohort, we studied 830 patients aged ≥ 65 years with VTE. MAIN MEASURES: We defined polypharmacy as the prescription of more than four different drugs. We assessed the association between polypharmacy and the time to a first major and clinically relevant non-major bleeding, accounting for the competing risk of death. We adjusted for known bleeding risk factors (age, gender, pulmonary embolism, active cancer, arterial hypertension, cardiac disease, cerebrovascular disease, chronic liver and renal disease, diabetes mellitus, history of major bleeding, recent surgery, anemia, thrombocytopenia) and periods of vitamin K antagonist treatment as a time-varying covariate. KEY RESULTS: Overall, 413 (49.8 %) patients had polypharmacy. The mean follow-up duration was 17.8 months. Patients with polypharmacy had a significantly higher incidence of major (9.0 vs. 4.1 events/100 patient-years; incidence rate ratio [IRR] 2.18, 95 % confidence interval [CI] 1.32-3.68) and clinically relevant nonmajor bleeding (14.8 vs. 8.0 events/100 patient-years; IRR 1.85, 95 % CI 1.27-2.71) than patients without polypharmacy. After adjustment, polypharmacy was significantly associated with major (sub-hazard ratio [SHR] 1.83, 95 % CI 1.03-3.25) and clinically relevant nonmajor bleeding (SHR 1.60, 95 % CI 1.06-2.42). CONCLUSIONS: Polypharmacy is associated with an increased risk of both major and clinically relevant nonmajor bleeding in elderly patients receiving vitamin K antagonists for VTE.

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The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology

Cited by 66 publications

References 47 publications

Venous Thromboembolism in Patients with Inflammatory Bowel Diseases

Venous Thromboembolism in Patients with Inflammatory Bowel Diseases

Predicting recurrence after unprovoked venous thromboembolism: prospective validation of the updated Vienna Prediction Model

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

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