CC BY 4.0 · TH Open 2018; 02(04): e428-e436
DOI: 10.1055/s-0038-1676359
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Outcomes beyond the Third Month of Anticoagulation in Patients Aged >75 Years with a First Episode of Unprovoked Venous Thromboembolism

Amaia Iñurrieta
1   Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
,
José María Pedrajas
1   Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
,
Manuel Jesús Núñez
2   Department of Internal Medicine, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
,
Luciano López-Jiménez
3   Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
,
Alba Velo-García
2   Department of Internal Medicine, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
,
Juan Carlos García
2   Department of Internal Medicine, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
,
Ramón Lecumberri
4   Department of Haematology, Clínica Universidad de Navarra, Pamplona, Spain
,
David Jiménez
5   Department of Pneumonology, Hospital Ramón y Cajal, Madrid, Spain
,
Isaac Pons
6   Department of Internal Medicine, Hospital de Igualada, Barcelona, Spain
,
Manuel Monreal
7   Department of Internal Medicine, Universidad Católica de Murcia, Hospital de Badalona Germans Trias i Pujol, Murcia, Spain
,
the RIETE Investigators › Author Affiliations
Further Information

Publication History

19 June 2018

09 October 2018

Publication Date:
10 December 2018 (online)

Abstract

Background The ideal duration of anticoagulant therapy in elderly patients with unprovoked venous thromboembolism (VTE) has not been consistently evaluated.

Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate and severity of pulmonary embolism (PE) recurrences versus major bleeding beyond the third month of anticoagulation in patients >75 years with a first episode of unprovoked VTE.

Results As of September 2017, 7,830 patients were recruited: 5,058 (65%) presented with PE and 2,772 with proximal deep vein thrombosis (DVT). During anticoagulant therapy beyond the third month (median, 113 days), 44 patients developed PE recurrences, 36 developed DVT recurrences, 101 had major bleeding, and 241 died (3 died of recurrent PE and 19 of bleeding). The rate of major bleeding was twofold higher than the rate of PE recurrences (2.05 [95% confidence interval, CI: 1.68–2.48] vs. 0.90 [95% CI: 0.66–1.19] events per 100 patient-years) and the rate of fatal bleeding exceeded the rate of fatal PE events (0.38 [95% CI: 0.24–0.58] vs. 0.06 [95% CI: 0.02–0.16] deaths per 100 patient-years). On multivariable analysis, patients who had bled during the first 3 months (hazard ratio [HR]: 4.32; 95% CI: 1.58–11.8) or with anemia at baseline (HR: 1.87; 95% CI: 1.24–2.81) were at increased risk for bleeding beyond the third month. Patients initially presenting with PE were at increased risk for PE recurrences (HR: 3.60; 95% CI: 1.28–10.1).

Conclusion Prolonging anticoagulation beyond the third month was associated with more bleeds than PE recurrences. Prior bleeding, anemia, and initial VTE presentation may help decide when to stop therapy.

* A full list of the RIETE investigators is given in Appendix A.