Département de Gérontologie Clinique, CHU de Saint-Etienne, Saint-Etienne, France.
INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France.
J Am Geriatr Soc. 2024 Jan;72(1):113-125. doi: 10.1111/jgs.18626. Epub 2023 Oct 10.
Age is a major risk factor for venous thromboembolism (VTE), yet patients aged ≥90 years are under-represented in clinical trials of anticoagulant therapy. The objectives were to describe and compare patient clinical characteristics, treatments, and outcomes (VTE recurrence, bleeding, and mortality) during the first 3 months of anticoagulation between VTE patients aged ≥90 years and those aged <90 years.
We analyzed data from the Registro Informatizado Enfermedad TromboEmbὀlica (RIETE), an ongoing global observational registry of patients with objectively confirmed acute VTE.
From January 2001 to October 2022, 96,701 patients were registered in RIETE, of whom 3262 (3.4%) were aged ≥90 years. Patients aged ≥90 years were less likely to be men, and to have experienced cancer or recent surgery, but more likely to manifest immobility, chronic heart failure, anemia, renal insufficiency, or dementia than those aged <90 years. Most (99.6%) patients aged ≥90 years were receiving anticoagulant therapy. During the first 3 months, 26 patients aged ≥90 years developed VTE recurrences, 116 experienced major bleeding, and 564 died. Among patients initially presenting with pulmonary embolism (PE), deaths due to PE exceeded those due to fatal bleeding (76 vs. 19). Among those initially presenting with isolated deep-vein thrombosis (DVT), it was the reverse (2 vs. 11 deaths).
In patients aged ≥90 years, the difference in the outcome of anticoagulant treatment depending on the initial presentation of VTE could suggest a need for different management approaches. Clinical trials evaluating the optimal duration of anticoagulation according to initial VTE presentation are warranted to limit excess deaths in this particular population.
年龄是静脉血栓栓塞症（VTE）的一个主要危险因素，但在抗凝治疗的临床试验中，年龄≥90 岁的患者代表性不足。本研究旨在描述和比较 VTE 患者年龄≥90 岁与<90 岁患者在抗凝治疗的前 3 个月内的患者临床特征、治疗方法和结局（VTE 复发、出血和死亡）。
我们分析了正在进行的全球急性 VTE 患者观察性登记研究——登记信息化血栓栓塞症（RIETE）的数据。
从 2001 年 1 月至 2022 年 10 月，RIETE 登记了 96701 例患者，其中 3262 例（3.4%）年龄≥90 岁。与<90 岁的患者相比，年龄≥90 岁的患者更可能为女性，且不太可能经历癌症或近期手术，但更可能表现为活动受限、慢性心力衰竭、贫血、肾功能不全或痴呆。大多数（99.6%）年龄≥90 岁的患者接受了抗凝治疗。在治疗的前 3 个月，3262 例年龄≥90 岁的患者中有 26 例发生 VTE 复发，116 例发生大出血，564 例死亡。在最初表现为肺栓塞（PE）的患者中，死于 PE 的人数超过了死于致命性出血的人数（76 例 vs. 19 例）。在最初表现为孤立性深静脉血栓形成（DVT）的患者中，情况则相反（2 例 vs. 11 例死亡）。
在年龄≥90 岁的患者中，根据 VTE 的初始表现，抗凝治疗结果的差异可能表明需要采用不同的管理方法。需要进行临床试验，根据初始 VTE 表现评估抗凝治疗的最佳持续时间，以限制该特定人群的过度死亡。
