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Venous thromboembolism in centenarians: Findings from the RIETE registry

Published:August 02, 2016DOI:https://doi.org/10.1016/j.ejim.2016.07.025

      Highlights

      • The safety of anticoagulation in patients aged ≥100 years with VTE is uncertain.
      • Many patients had renal insufficiency or anemia, or were taking antiplatelets.
      • Most were treated at full therapeutic doses. Mean duration of therapy was 131 days.
      • The rate of VTE recurrences during therapy outweighed the rate of bleeds.

      Abstract

      Background

      The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100 years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain.

      Methods

      We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100 years.

      Results

      Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100 years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168 ± 42 IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148 ± 51 IU/kg/day). During the course of anticoagulant therapy (mean duration, 139 days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported.

      Conclusions

      Among patients with acute VTE aged ≥100 years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency.

      Keywords

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