Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants

Tritschler, Tobias; Castellucci, Lana A; Es, Nick van; Aujesky, Drahomir; Gal, Grégoire Le

doi:10.20452/pamw.15225

Cited by 5 publications

(5 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The group size was relatively small, but VTE despite thromboprophylaxis is infrequent [4]. Additionally, our results cannot be applied to other groups of patients such as the elderly, those with cancer, or recent cardiovascular events, known to affect fibrin clot features [13][14][15]. No laboratory investigations were performed during follow-up and some variables including fibrinogen may change over time, but nonetheless, the data at baseline have a prognostic value in this clinical setting.…”

Section: Discussionmentioning

confidence: 90%

Unfavorably altered fibrin clot properties are associated with recurrent venous thromboembolism in medical patients following post-discharge events

Undas¹,

Siudut²,

Ząbczyk³

2022

Polish Archives of Internal Medicine

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 90%

Unfavorably altered fibrin clot properties are associated with recurrent venous thromboembolism in medical patients following post-discharge events

Undas¹,

Siudut²,

Ząbczyk³

2022

Polish Archives of Internal Medicine

View full text Add to dashboard Cite

“…Calibration of the CHAP model may vary between patients receiving VKA and DOACs because DOACs are potentially associated with a lower risk of major bleeding during extended anticoagulation compared with VKAs, 38 and, consequently, patients receiving DOACs who were classified at high risk of bleeding may not have an annual bleeding risk >2.5%. However, point estimates of hazard ratios for those at high bleeding risk (vs those not at high risk) and major bleeding rates in high-risk patients were similar for VKAs (3.9 major bleeding events per 100 person-years) and DOACs (4.9 major bleeding events per 100 person-years), and evidence from randomized trials does not suggest an interaction in terms of bleeding risk between type of anticoagulant and creatinine, 39 hemoglobin, 17 age, 39, 40 and antiplatelet therapy. 41 Second, fatal bleeding was rare, and, consequently, estimates of case-fatality rates of major bleeding according to subgroups of predicted bleeding risk were imprecise.…”

Section: Discussionmentioning

confidence: 91%

Predicting major bleeding during extended anticoagulation for unprovoked or weakly provoked venous thromboembolism

et al. 2022

View full text Add to dashboard Cite

No clinical prediction model has been specifically developed or validated to identify patients with unprovoked venous thromboembolism (VTE) who are at high risk of major bleeding during extended anticoagulation. In a prospective multinational cohort study of patients with unprovoked VTE receiving extended anticoagulation after completing ≥3 months of initial treatment, we derived a new clinical prediction model using a multivariable Cox regression model based on 22 pre-specified candidate predictors for the primary outcome of major bleeding. This model was then compared with modified versions of five existing clinical scores. A total of 118 major bleeding events occurred in 2516 patients (annual risk, 1.7%; 95% confidence interval, 1.4-2.1). Incidence of major bleeding events per 100 person-years in high- and non-high-risk patients, respectively, were 3.9 (95% confidence interval, 3.0-5.1) and 1.1 (0.8-1.4) using the newly derived CHAP model (creatinine, hemoglobin, age, and use of antiplatelet agent), 3.3 (2.6-4.1) and 1.0 (0.7-1.3) using modified ACCP, 5.3 (0.6-19.2) and 1.7 (1.4-2.0) using modified RIETE, 3.1 (2.3-3.9) and 1.1 (0.9-1.5) using modified VTE-BLEED, 5.2 (3.3-7.8) and 1.5 (1.2-1.8) using modified HAS-BLED, and 4.8 (1.3-12.4) and 1.7 (1.4-2.0) using modified OBRI scores. Modified versions of the ACCP, VTE-BLEED, and HAS-BLED scores help identify patients with unprovoked VTE who are at high risk of major bleeding and should be considered for discontinuation of anticoagulation after 3-6 months of initial treatment. The CHAP model may further improve estimation of bleeding risk by using continuous predictor variables, but external validation is required before its implementation in clinical practice.-

show abstract

“…43 , 44 In meta-analyses of clinical trials, DOACs reduced the risk of MB by up to 60% compared with VKAs in older persons with VTE, at least during the first 3 months of treatment. 20 , 50 , 51 MB may also have a lower case-fatality in patients treated with DOACs. 52 Thus, our results based on data from the pre-DOAC era may not extrapolable to older patients with VTE who are treated with DOACs.…”

Section: Discussionmentioning

confidence: 99%

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

et al. 2023

View full text Add to dashboard Cite

Elderly patients anticoagulated for venous thromboembolism (VTE) have an increased risk of bleeding compared to younger patients. Little is known about the clinical impact of anticoagulation-related bleeding in this growing patient group. To prospectively assess the incidence, clinical impact, and predictors of bleeding in elderly patients anticoagulated for VTE. We analyzed 981 patients aged ≥65 years with acute VTE in a prospective multicenter cohort. 88% were anticoagulated with vitamin K antagonists. Outcomes were the occurrence of a major (MB) or clinically relevant non-major bleeding (CRNMB) during the initial anticoagulation period up to 36 months. We described the incidence and clinical impact of bleeding and examined the association between risk factors and time to a first bleeding using competing risk regression. 100 MB and 125 CRNMB occurred during follow-up. The incidence of MB and CRNMB was 8.5 (95%CI 7.0-10.4) and 13.4 events (95%CI 11.4-15.7) per 100 patient-years, respectively. In patients with MB, 79% required hospitalization, 18% a surgical intervention, and 19% a permanent discontinuation of anticoagulation. 15% of MB were intracranial and 6% fatal. After adjustment, active cancer (sub-hazard ratio [SHR] 1.81, 95%CI 1.12-2.93) and low physical activity (SHR 1.88, 95%CI 1.19-2.98) were associated with MB, and high risk of falls with CRNMB (SHR 2.04, 95%CI 1.39-3.00). Older patients anticoagulated for VTE had a high incidence of MB and CRNMB, and these bleeding episodes caused a great burden of disease. Physicians should carefully weigh the risks/benefits of extended anticoagulation in the older population with VTE.

show abstract

Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants

Cited by 5 publications

References 51 publications

Unfavorably altered fibrin clot properties are associated with recurrent venous thromboembolism in medical patients following post-discharge events

Unfavorably altered fibrin clot properties are associated with recurrent venous thromboembolism in medical patients following post-discharge events

Predicting major bleeding during extended anticoagulation for unprovoked or weakly provoked venous thromboembolism

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

Contact Info

Product

Resources

About