Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE).
OBJECTIVE
Elderly patients with venous thromboembolism (VTE) have an increased rate of bleeding complications on therapeutic doses of anticoagulant therapy.


METHODS
Using data in RIETE, an international registry of consecutive patients with objectively confirmed, symptomatic acute VTE, we analyzed the clinical characteristics and outcome within 90 days of therapy of all enrolled patients aged > or = 80 years old.


RESULTS
Of the 13,011 patients with VTE enrolled in RIETE up tp September 2005, 2890 (22%) were aged > or = 80 years old. During the study period 99 patients (3.4%) aged > or = 80 years, and 212 aged < 80 years (2.1%) had major bleeding events (odds ratio: 1.7; 95% CI: 1.3-2.1). Fatal bleeding occurred in 0.8% and 0.4%, respectively (odds ratio: 2.0; 95% CI: 1.2-3.4). The incidence of recurrent VTE was 2.1% and 2.8%. However, 3.7% of patients > or = 80 years and 1.1% < 80 years died of pulmonary embolism (PE) (odds ratio: 3.6; 95% CI: 2.7-4.7). On multivariate analysis, patients > or = 80 years with symptomatic PE, heart failure, long-term therapy with low-molecular-weight heparin (LMWH) or a vena cava filter had an increased risk of recurrent VTE. Those with recent bleeding, abnormal renal function, use of corticosteroids or long-term therapy with LMWH had an increased risk of major bleeding.


CONCLUSIONS
In patients aged > or = 80 years old the 3.4% incidence of major bleeding exceeded the 2.1% incidence of VTE recurrences. However, the 3.7% incidence of fatal PE outweighed the 0.8% of fatal bleeding. Thus, there seems to be more reason to be concerned about fatal PE than about bleeding in elderly patients with VTE.
López-Jiménez
Luciano
L
Servicio de Medicina Interna, Hospital Universitario, Reina Sofía, Córdoba, Spain.
Montero
Manuel
M
González-Fajardo
José Antonio
JA
Arcelus
Juan Ignacio
JI
Suárez
Carmen
C
Lobo
José Luís
JL
Monreal
Manuel
M
D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000503:physiopathology*; D020246:Venous Thrombosis / Q000401:mortality / Q000503:physiopathology*