title: Anticoagulation Management Practices and Outcomes in Elderly Patients with Acute Venous Thromboembolism: A Clinical Research Study.
abstract: Whether anticoagulation management practices are associated with improved outcomes in elderly patients with acute venous thromboembolism (VTE) is uncertain. Thus, we aimed to examine whether practices recommended by the American College of Chest Physicians guidelines are associated with outcomes in elderly patients with VTE. We studied 991 patients aged ≥65 years with acute VTE in a Swiss prospective multicenter cohort study and assessed the adherence to four management practices: parenteral anticoagulation ≥5 days, INR ≥2.0 for ≥24 hours before stopping parenteral anticoagulation, early start with vitamin K antagonists (VKA) ≤24 hours of VTE diagnosis, and the use of low-molecular-weight heparin (LMWH) or fondaparinux. The outcomes were all-cause mortality, VTE recurrence, and major bleeding at 6 months, and the length of hospital stay (LOS). We used Cox regression and lognormal survival models, adjusting for patient characteristics. Overall, 9% of patients died, 3% had VTE recurrence, and 7% major bleeding. Early start with VKA was associated with a lower risk of major bleeding (adjusted hazard ratio 0.37, 95% CI 0.20-0.71). Early start with VKA (adjusted time ratio [TR] 0.77, 95% CI 0.69-0.86) and use of LMWH/fondaparinux (adjusted TR 0.87, 95% CI 0.78-0.97) were associated with a shorter LOS. An INR ≥2.0 for ≥24 hours before stopping parenteral anticoagulants was associated with a longer LOS (adjusted TR 1.2, 95% CI 1.08-1.33). In elderly patients with VTE, the adherence to recommended anticoagulation management practices showed mixed results. In conclusion, only early start with VKA and use of parenteral LMWH/fondaparinux were associated with better outcomes.
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Charlène
authors.initials: C
authors.lastname: Insam
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Méan
authors.affiliation: Clinical Trial Unit Bern, Department of Clinical Research and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Limacher
authors.affiliation: University Clinic of Hematology and Hematologic Central Laboratory, Bern University Hospital, Bern, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Angelillo-Scherrer
authors.affiliation: Department of Angiology, Basel University Hospital, Basel, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Aschwanden
authors.affiliation: Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Banyai
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
authors.forename: Juerg-Hans
authors.initials: JH
authors.lastname: Beer
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
authors.affiliation: Division of Diabetology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Egloff
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Frauchiger
authors.affiliation: Department of Angiology, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Husmann
authors.affiliation: Division of Angiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
authors.affiliation: University Clinic of Hematology and Hematologic Central Laboratory, Bern University Hospital, Bern, Switzerland.|Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
authors.affiliation: Cardiovascular Research, Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Matter
authors.affiliation: Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Osterwalder
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.affiliation: Department of Angiology, Basel University Hospital, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Staub
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy*; D016903:Drug Monitoring
chemical_list: D000925:Anticoagulants