Respiratory Department, Hospital Dr. Peset, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain.
Respiratory Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain; Medicine Department, Universidad de Alcalá, Madrid, Spain.
Arch Bronconeumol. 2024 Mar;60(3):143-152. doi: 10.1016/j.arbres.2023.12.016. Epub 2024 Jan 3.
Although older adults represent a significant proportion of patients with venous thromboembolism (VTE), the data on the impact of age-related differences in the clinical presentation, management, and outcomes of VTE are scarce.
We analyzed data from the RIETE registry database, an ongoing global observational registry of patients with objectively confirmed VTE, to compare patient characteristics, clinical presentation, treatments, and outcomes between elderly (≥70 years) vs. non-elderly (<70 years) patients.
From January 2001 to March 2021, 100,000 adult patients were enrolled in RIETE. Elderly patients (47.9%) were more frequently women (58.2% vs. 43.5%), more likely had unprovoked VTE (50.5% vs. 45.1%) and most often presented with severe renal failure (10.2% vs. 1.2%) and acute pulmonary embolism (PE) (vs. deep vein thrombosis) (54.3% vs. 44.5%) compared to non-elderly patients (p<0.001 for all comparisons). For the PE subgroup, elderly patients more frequently had non-low risk PE (78.9% vs. 50.7%; p<0.001), respiratory failure (33.9% vs. 21.8%; p<0.001) and myocardial injury (40.0% vs. 26.2%; p<0.001) compared to non-elderly patients. Thrombolysis (0.9% vs. 1.7%; p<0.001) and direct oral anticoagulants (8.8% vs. 11.8%; p<0.001) were less frequently administered to elderly patients. Elderly patients showed a significantly higher 30-day all-cause mortality (adjusted odds ratio [OR] 1.36, 95%CI: 1.22-1.52) and major bleeding (OR, 2.08; 95%CI, 1.85-2.33), but a lower risk of 30-day VTE recurrences (OR, 0.62, 95%CI, 0.54-0.71).
Compared with non-elderly patients, elderly patients had a different VTE clinical profile. Advanced therapies were less frequently used in older patients. Age was an independent predictor of mortality.
尽管老年人在静脉血栓栓塞症（VTE）患者中占很大比例，但关于年龄相关差异对 VTE 的临床表现、治疗和结局影响的数据还很缺乏。
我们分析了 RIETE 登记数据库的数据，该数据库是一个正在进行的全球客观确诊 VTE 患者观察性登记，以比较老年（≥70 岁）与非老年（<70 岁）患者之间的患者特征、临床表现、治疗和结局。
从 2001 年 1 月至 2021 年 3 月，RIETE 登记了 10 万名成年患者。老年患者（47.9%）更常为女性（58.2%比 43.5%），更可能患有无诱因 VTE（50.5%比 45.1%），更常出现严重肾衰竭（10.2%比 1.2%）和急性肺栓塞（PE）（比深静脉血栓形成）（54.3%比 44.5%），而非老年患者（所有比较均<0.001）。对于 PE 亚组，老年患者更常患有非低危 PE（78.9%比 50.7%；<0.001）、呼吸衰竭（33.9%比 21.8%；<0.001）和心肌损伤（40.0%比 26.2%；<0.001），而非老年患者。与非老年患者相比，老年患者接受溶栓治疗（0.9%比 1.7%；<0.001）和直接口服抗凝剂（8.8%比 11.8%；<0.001）的比例较低。老年患者 30 天全因死亡率（调整比值比 [OR] 1.36，95%CI：1.22-1.52）和大出血（OR，2.08；95%CI，1.85-2.33）显著升高，但 30 天 VTE 复发风险（OR，0.62，95%CI，0.54-0.71）降低。
与非老年患者相比，老年患者 VTE 的临床表现不同。高龄患者较少接受高级治疗。年龄是死亡率的独立预测因素。
