Venous thromboembolism in older adults: A community-based study
Department of Medicine; Meyers Primary Care Institute; Department of Quantitative Health Sciences
Medical Subject Headings
Age Factors; Aged; Aged, 80 and over; Anticoagulants; Drug Administration Schedule; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Proportional Hazards Models; Prospective Studies; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome; *Venous Thromboembolism; Warfarin
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Geriatrics
BACKGROUND: While the incidence of venous thromboembolism increases with age, little is known about its contemporary management or outcomes in older patients. Our goal was to compare the characteristics, treatment, and outcomes associated with venous thromboembolism, in patients aged 65-69 years, 70-74 years, 75-79 years, and 80+ years.
METHODS/PARTICIPANTS: We prospectively followed 542 subjects aged >/=65 years with venous thromboembolism from January 2008 through August 2011 at 6 sites. In addition, a retrospective study of 681 additional subjects aged >/=65 years with venous thromboembolism diagnosed in 2007 and 2009 was conducted at the same 6 sites.
RESULTS: With advancing age, patients were more likely to suffer provoked venous thromboembolism but less likely to present with pulmonary embolism. Patients with unprovoked, provoked, or malignancy-associated venous thromboembolism received warfarin for a median of 401 days, 203 days, and 529 days, respectively. Age >/=80 years was not associated with an increased risk of recurrent venous thromboembolism, but there was an increased risk of all-cause mortality.
CONCLUSION: With advancing age, patients are more likely to suffer hospital-associated and provoked venous thromboembolism. Many elderly patients with provoked or unprovoked venous thromboembolism were treated for >3 months or >12 months, respectively. Given that advanced age was not associated with increased risk of recurrent venous thromboembolism, but elderly patients in general have a higher risk of bleeding from continued anticoagulant therapy, such practice is potentially harmful. At the same time, such an argument could be used to more vigorously offer prophylaxis in the first place.
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Citation: Am J Med. 2014 Jun;127(6):530-7.e3. doi: 10.1016/j.amjmed.2014.02.011.Link to article on publisher's site
Spencer, Frederick A.; Gurwitz, Jerry H.; Schulman, Sam; Linkins, Lori-Ann; Crowther, Mark A.; Ginsberg, Jeffrey S.; Lee, Agnes Y. Y.; Saczynski, Jane S.; Anand, Sonia; Lessard, Darleen M.; Emery, Catherine; Huang, Wei; and Goldberg, Robert J., "Venous thromboembolism in older adults: A community-based study" (2014). Meyers Primary Care Institute Publications and Presentations. 683.