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Venous thromboembolism in nonagenarians Findings from the RIETE Registry

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Recent advances in vascular biology: Selected highlights from IVBM 2008

DOI: https://doi.org/10.1160/TH08-12-0827
Issue: 2009: 101/6 (June) pp. 796-1180
Pages: 1112-1118

Venous thromboembolism in nonagenarians Findings from the RIETE Registry

Beatriz Vasco 1; Joan Carles Villalba 2; Luciano Lopez-Jimenez 3; Conxita Falga 4; Julio Montes 5; Javier Trujillo-Santos 6; Manuel Monreal 7; for the RIETE Investigators*
1 Servicio de Hematología, Hospital Virxe da Xunqueira, Coruña, Spain; 2 Unidad de Cuidados Intensivos, Hospital Universitari Germans Trias i Pujol, Badalona, Facultat de Medicina, Universitat Autónoma de Barcelona, Spain; 3 Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, Spain; 4 Servicio de Medicina Interna, Consorci Sanitari del Maresme, Mataró, Spain; 5 Servicio de Medicina Interna, Hospital de Meixoeiro, Vigo, Spain; 6 Servicio de Medicina Interna, Hospital Universitario Santa María de Rosell, Cartagena, Murcia, Spain; 7 Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Keywords

Elderly, venous thromboembolism, outcome

Summary

The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥90 years with venous thromboembolism (VTE) is uncertain. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. We evaluated the efficacy and safety of anticoagulant therapy during the first three months in all patients aged ≥90 years. In addition, we tried to identify those at a higher risk for VTE. Of 21,873 patients enrolled from March 2001 to February 2008, 610 (2.8%) were aged ≥90 years. Of these, 307 (50%) presented with pulmonary embolism (PE), 240 (39%) had immobility ≥4 days, and 271 (44%) had abnormal creatinine levels. During the first three months of therapy, 140 patients aged ≥90 years (23%) died. Of these, 45 (32%) died of PE (34 of the initial episode, 11 of recurrent PE), 18 (13%) had fatal bleeding. Recent immobility ≥4 days was the most common risk factor for VTE (240 of 610 patients, 39%), but only 54 of them (22%) had received thromboprophylaxis. The most frequent causes for immobility were senile dementia, acute infection, trauma or decompensated heart failure. The duration of immobility was <4 weeks in 126 patients (52%), and most of them were bedridden at home. In conclusion, one in every four VTE patients aged ≥90 years died during the first three months of therapy. Of these, one in every three died of PE, one in every eight had fatal bleeding. Identifying at-risk patients may help to prevent some of these deaths.

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