Beotra Eishan, Ngian Vincent J J, Tran Fiona, Hsu Kelvin, O'Rourke Fintan, Ong Bin S
South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
Department of Ambulatory Medicine and Medical Assessment Unit, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia.
Int J Gen Med. 2024 Oct 2;17:4485-4491. doi: 10.2147/IJGM.S475403. eCollection 2024.
Treatment for pulmonary embolism has expanded to include Direct Oral Anticoagulants (DOACs). The incidence of pulmonary-embolism (PE) in "oldest-old" age group (≥85 years) is rapidly increasing, but there is limited research on its management and clinical outcomes.
To examine the differences in management and outcomes in those aged ≥85 years compared to other age groups.
We performed a retrospective cohort-study of 373 consecutive patients with pulmonary embolism confirmed on imaging by Computed Tomography Pulmonary Angiogram (CTPA) or Ventilation Perfusion (VQ) Scan at a principal referral hospital in Sydney, Australia. Data collected include clinical and demographic data, Charlson comorbidity index, treatment type and outcomes including complications, recurrent venous thromboembolism, and mortality.
Across the age groups, DOACS were prescribed to 53.4% (n=199) of patients. In oldest-old patients with PE, LMWH bridging to warfarin was the most frequently prescribed treatment, used in 46.2% (n=18, 95% CI: 30.8%-61.5%, p=0.003) of these patients. The mortality rate for patients on LMWH was 13.9% (n=5, 95% CI: 4.2%-37.5%, p=0.553). Overall, major bleeding incidents were rare, occurring in just 1.7% (n=4, 95% CI: 0.4%-3.3%) of patients, with no significant differences in outcomes across age groups.
DOACs are increasingly used as the treatment modality of choice in atrial fibrillation but are less well studied in pulmonary embolism, particularly in oldest-old patients. We found that the safety and efficacy profile of DOACs in pulmonary embolism treatment is similar across the age groups. Our study does not support any change in treatment protocols of PE in the oldest old, but further studies are required to confirm our findings.
肺栓塞的治疗方法已扩展至包括直接口服抗凝剂（DOACs）。“高龄老人”（≥85岁）年龄组中肺栓塞（PE）的发病率正在迅速上升，但关于其管理和临床结局的研究有限。
研究≥85岁人群与其他年龄组在管理和结局方面的差异。
我们对澳大利亚悉尼一家主要转诊医院373例经计算机断层扫描肺动脉造影（CTPA）或通气灌注（VQ）扫描成像确诊为肺栓塞的连续患者进行了一项回顾性队列研究。收集的数据包括临床和人口统计学数据、查尔森合并症指数、治疗类型以及结局，包括并发症、复发性静脉血栓栓塞和死亡率。
在各年龄组中，53.4%（n = 199）的患者使用了DOACs。在高龄老人PE患者中，低分子肝素桥接华法林是最常用的治疗方法，这些患者中有46.2%（n = 18，95%CI：30.8%-61.5%，p = 0.003）使用了该方法。接受低分子肝素治疗的患者死亡率为13.9%（n = 5，95%CI：4.2%-37.5%，p = 0.553）。总体而言，大出血事件很少见，仅1.7%（n = 4，95%CI：0.4%-3.3%）的患者发生，各年龄组的结局无显著差异。
DOACs越来越多地被用作心房颤动的首选治疗方式，但在肺栓塞方面的研究较少，尤其是在高龄老人中。我们发现DOACs在肺栓塞治疗中的安全性和有效性在各年龄组中相似。我们的研究不支持改变高龄老人PE的治疗方案，但需要进一步研究来证实我们的发现。
