An understudied group that is at risk for venous thromboembolism (VTE), patients aged 90 years or older had outcomes with anticoagulation different from those in adults younger than 90 years, a study shows. These results “could suggest a need for different management approaches,” the authors conclude. “Clinical trials evaluating the optimal duration of anticoagulation according to initial VTE presentation are warranted to limit excess deaths in this particular population.“
Prospectively collected data from an ongoing global observational registry of patients with objectively confirmed acute VTE, the Registro Informatizado Enfermedad TromboEmbὀlica (RIETE), provided these insights into patient outcomes during the first 3 months of anticoagulation: “From January 2001 to October 2022, 96,701 patients were registered in RIETE, of whom 3,262 (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, it was the reverse (2 vs. 11 deaths).”