The adherence to initial processes of care in elderly patients with acute venous thromboembolism

PLoS One. 2014 Jul 1;9(7):e100164. doi: 10.1371/journal.pone.0100164. eCollection 2014.


Background: We aimed to assess whether elderly patients with acute venous thromboembolism (VTE) receive recommended initial processes of care and to identify predictors of process adherence.

Methods: We prospectively studied in- and outpatients aged ≥65 years with acute symptomatic VTE in a multicenter cohort study from nine Swiss university- and non-university hospitals between September 2009 and March 2011. We systematically assessed whether initial processes of care, which are recommended by the 2008 American College of Chest Physicians guidelines, were performed in each patient. We used multivariable logistic models to identify patient factors independently associated with process adherence.

Results: Our cohort comprised 950 patients (mean age 76 years). Of these, 86% (645/750) received parenteral anticoagulation for ≥5 days, 54% (405/750) had oral anticoagulation started on the first treatment day, and 37% (274/750) had an international normalized ratio (INR) ≥2 for ≥24 hours before parenteral anticoagulation was discontinued. Overall, 35% (53/153) of patients with cancer received low-molecular-weight heparin monotherapy and 72% (304/423) of patients with symptomatic deep vein thrombosis were prescribed compression stockings. In multivariate analyses, symptomatic pulmonary embolism, hospital-acquired VTE, and concomitant antiplatelet therapy were associated with a significantly lower anticoagulation-related process adherence.

Conclusions: Adherence to several recommended processes of care was suboptimal in elderly patients with VTE. Quality of care interventions should particularly focus on processes with low adherence, such as the prescription of continued low-molecular-weight heparin therapy in patients with cancer and the achievement of an INR ≥2 for ≥24 hours before parenteral anticoagulants are stopped.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Cohort Studies
  • Female
  • Guideline Adherence*
  • Humans
  • Inpatients
  • Male
  • Multivariate Analysis
  • Neoplasms / complications
  • Outpatients
  • Practice Guidelines as Topic
  • Risk Factors
  • Stockings, Compression
  • Time Factors
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / therapy


  • Anticoagulants

Grants and funding

The study was funded by a grant from the Swiss National Science Foundation (33CSCO-122659/139470). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.