title: Certoparin versus UFH to prevent venous thromboembolic events in the very elderly patient: an analysis of the CERTIFY study.
abstract: BACKGROUND
  There is an exponential rise of thromboembolic risk with age because of co-morbidities, immobility and pharmacotherapy. We aimed to investigate the benefits and risks of heparin prophylaxis in very elderly patients ≥80 years and the type of heparin used in a subgroup analysis of the CERTIFY trial.
  
  
  METHODS
  3,239 patients were randomized to 3,000 U aXa o.d. certoparin or 5,000 IU t.i.d. unfractionated heparin (UFH) for 8-20 days.
  
  
  RESULTS
  Patients ≥80 years (n=1,365) were more likely to be female, had a lower mean bodyweight, were more frequently using antiplatelets and had a GFR below 30 ml/min/1.73 m(2) more often than patients <80 years (n=1,875). The combined endpoint of proximal DVT, symptomatic non-fatal PE and VTE related death was experience by 5.26% of patients ≥80 years versus 3.51% in younger patients (OR 1.53; 95%CI 1.05-2.21; p=0.03). There were no significant differences in both minor (OR 1.11; 95%CI 0.75-1.62) and major (OR 2.53; 95%CI 0.93-6.86) bleeding risks. Certoparin and UFH were equally effective in reducing thromboembolic risk in either age group. The risk of any (OR 0.45; 95%CI 0.26-0.79) and minor bleeding (OR 0.42; 95%CI 0.23-0.78) was reduced with certoparin in the very elderly only. There were more adverse events in elderly patients (OR 1.26; 95%CI 1.1-1.46), but rates were otherwise comparable.
  
  
  CONCLUSIONS
  The analysis confirmed the increased thromboembolic risk in very elderly patients, but demonstrated no increased bleeding risk. Certoparin and UFH were equally effective and safe with a reduced risk of minor bleeding complications with certoparin in the very elderly.
authors.affiliation: Klinikum Friedrichstadt, Dresden, Germany. schellong-se@khdf.de
authors.forename: S M
authors.initials: SM
authors.lastname: Schellong
authors.forename: H-E
authors.initials: HE
authors.lastname: Gerlach
authors.forename: U
authors.initials: U
authors.lastname: Tebbe
authors.forename: S
authors.initials: S
authors.lastname: Haas
authors.forename: N
authors.initials: N
authors.lastname: Melzer
authors.forename: C
authors.initials: C
authors.lastname: Abletshauser
authors.forename: C
authors.initials: C
authors.lastname: Sieder
authors.forename: P
authors.initials: P
authors.lastname: Bramlage
authors.forename: H
authors.initials: H
authors.lastname: Riess
authors.forename: R
authors.initials: R
authors.lastname: Bauersachs
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants; D018890:Chemoprevention; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011292:Premedication; D012306:Risk; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; C403769:certoparin