Advertisement

Venous thromboembolism in young adults: Findings from the RIETE registry

Published:March 11, 2019DOI:https://doi.org/10.1016/j.ejim.2019.02.007

      Summary

      Background

      Little is known on the clinical characteristics, risk factors and outcomes during anticoagulation in young patients with acute venous thromboembolism (VTE).

      Methods

      We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to assess the clinical characteristics, risk factors and outcomes during anticoagulation in VTE patients aged 10–24 years. Data were separately analyzed according to initial presentation and gender.

      Results

      Of 76,719 patients with VTE, 1571 (2.0%) were aged 10–24 years. Of these, 989 (63%) were women and 669 (43%) presented with pulmonary embolism (PE). Most women were using estrogens (680, 69%) or were pregnant (101, 10%), while 59% of men had unprovoked VTE. Women were more likely to present with PE (48% vs. 34%). The majority (87%) of PE patients had Sat O2 levels ≥90% at baseline. The vast majority (97%) of PE patients were at low risk according to the PESI score, many (90%) at very low risk. During the course of anticoagulation (median, 192 days), 40 patients had VTE recurrences, 17 had major bleeding and 10 died (3 died of PE). Women had as many VTE recurrences as major bleeds (15 vs. 14 events), while men had many more VTE recurrences than major bleeding (25 vs. 3 events).

      Conclusions

      VTE is associated with low risk of short-term mortality in young adults. Noticeable gender differences exist in the risk factor profile and the risk of VTE recurrences and major bleeding in the course of anticoagulation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Weinberg I.
        • Hawkins B.M.
        • Hariharan P.
        • Okechukwu I.
        • Parry B.A.
        • Chang Y.
        • et al.
        A comparison of patients diagnosed with pulmonary embolism who are ≥65 years with patients <65 years.
        Am J Cardiol. 2015; 115: 681-686
        • López-Jiménez L.
        • Montero M.
        • González-Fajardo J.A.
        • Arcelus J.I.
        • Suárez C.
        • Lobo J.L.
        • et al.
        Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE).
        Haematologica. 2006; 91: 1046-1051
        • Stein P.D.
        • Matta F.
        Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism.
        Crit Care Clin. 2011; 27: 907-932
        • Sabapathy C.A.
        • Djounang T.N.
        • Kahn S.R.
        • Platt R.W.
        • Tagalakis V.
        Incidence trends and mortality from childhood venous thromboembolism: a population-based cohort study.
        J Pediatr. 2016; 172: 175-180
        • Meier K.A.
        • Clark E.
        • Tarango C.
        • Chima R.S.
        • Shaughnessy E.
        Venous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis.
        Hosp Pediatr. 2015; 5: 44-51
        • Hennessey C.A.
        • Patel V.K.
        • Tefera E.A.
        • Gomez-Lobo V.
        Venous thromboembolism in female adolescents: patient characteristics.
        J Pediatr Adolesc Gynecol. 2018; 31: 503-508
        • Kohorst M.A.
        • Warad D.M.
        • Nageswara Rao A.A.
        • Rodriguez V.
        Obesity, sedentary lifestyle, and video games: The new thrombophilia cocktail in adolescents.
        Pediatr Blood Cancer. 2018; 65e27041
        • Kiluk I.E.
        • Krajewska A.
        • Kosacka U.
        • Tyciñska A.
        • Milewski R.
        • Musia W.
        • et al.
        Different manifestations of pulmonary embolism in younger compared to older patients: clinical presentation, prediction rules and long-term outcomes.
        Adv Med Sci. 2017; 62: 254-258
        • Spentzouris G.
        • Scriven R.J.
        • Lee T.K.
        • Labropoulos N.
        Pediatric venous thromboembolism in relation to adults.
        J Vasc Surg. 2012; 55: 1785-1793
        • Bikdeli B.
        • Jiménez D.
        • Hawkins M.
        • Ortíz S.
        • Prandoni P.
        • Brenner B.
        • et al.
        Rationale, design and methodology of the computerized registry of patients with venous thromboembolism (RIETE).
        Thromb Haemost. 2018; 118: 214-224
        • World Health Organization
        • Aujesky D.
        • Obrosky D.S.
        • Stone R.A.
        • Auble T.E.
        • Perrier A.
        • Cornuz J.
        • et al.
        Derivation and validation of a prognostic model for pulmonary embolism.
        Am J Respir Crit Care Med. 2005; 172: 1041-1046
        • Jiménez D.
        • Aujesky D.
        • Moores L.
        • Gómez V.
        • Lobo J.L.
        • Uresandi F.
        • et al.
        Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.
        Arch Intern Med. 2010; 170: 1383-1389
        • Moysidis T.
        • Kröger K.
        • Santosa F.
        • Gröchenig E.
        Pulmonary embolism in young males and females in Germany: data from the Federal Statistical Office.
        Blood Coagul Fibrinolysis. 2010; 21: 511-515
        • Santosa F.
        • Moerchel Ch.
        • Berg Ch.
        • Kröger K.
        Disproportional increase of pulmonary embolism in young females in Germany: trends from 2005 to 2014.
        J Thromb Thrombolysis. 2017; 43: 417-422
        • Von Beckerath O.
        • Santosa F.
        • Waldhausen R.
        • Moerchel C.
        • Kröger K.
        Thromboembolic disease in females and males aged 10 to 39 years in Germany.
        Vasa. 2018; 11: 1-7
        • Scheres L.J.J.
        • Brekelmans M.P.A.
        • Beenen L.F.M.
        • Büller H.R.
        • Cannegieter S.C.
        • Middeldorp S.
        Sex-specific differences in the presenting location of a first venous thromboembolism.
        J Thromb Haemost. 2017; 15: 1344-1350
        • Mongan J.
        • Kline J.
        • Smith-Bindman R.
        Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients.
        Emerg Med J. 2015; 32: 840-845
        • Smith-Bindman R.
        • Lipson J.
        • Marcus R.
        • Kim K.P.
        • Mahesh M.
        • Gould R.
        • et al.
        Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
        Arch Intern Med. 2009; 169: 2078-2086
        • Mitchell A.M.
        • Jones A.E.
        • Tumlin J.A.
        • Kline J.A.
        Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography.
        Acad Emerg Med. 2012; 19: 618-625
        • Barco S.
        • Klok F.A.
        • Mahé I.
        • Marchena P.J.
        • Ballaz A.
        • Rubio C.M.
        • et al.
        Impact of sex, age, and risk factors for venous thromboembolism on the initial presentation of first isolated symptomatic acute deep vein thrombosis.
        Thromb Res. 2019; 173: 166-171
        • Lijfering W.M.
        • Veeger N.J.
        • Middeldorp S.
        • Hamulyák K.
        • Prins M.H.
        • Büller H.R.
        • et al.
        A lower risk of recurrent venous thrombosis in women compared with men is explained by sex-specific risk factors at time of first venous thrombosis in thrombophilic families.
        Blood. 2009; 114: 2031-2036
        • Blanco-Molina A.
        • Enea I.
        • Gadelha T.
        • Tufano A.
        • Bura-Rivière A.
        • Di Micco P.
        • et al.
        Sex differences in patients receiving anticoagulant therapy for venous thromboembolism.
        Medicine (Baltimore). 2014; 93: 309-317