Venous thromboembolism in centenarians: Findings from the RIETE registry

Eur J Intern Med. 2016 Dec;36:62-66. doi: 10.1016/j.ejim.2016.07.025. Epub 2016 Aug 3.

Abstract

Background: The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain.

Methods: We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100years.

Results: Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168±42IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148±51IU/kg/day). During the course of anticoagulant therapy (mean duration, 139days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported.

Conclusions: Among patients with acute VTE aged ≥100years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency.

Keywords: Anticoagulants; Centenarians; Outcome; Venous thromboembolism.

MeSH terms

  • Aged, 80 and over
  • Anemia / epidemiology
  • Anticoagulants / therapeutic use*
  • Comorbidity
  • Female
  • Heart Failure / epidemiology
  • Hemorrhage / chemically induced*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Male
  • Pulmonary Embolism / drug therapy*
  • Pulmonary Embolism / epidemiology
  • Recurrence
  • Registries*
  • Renal Insufficiency / epidemiology
  • Spain / epidemiology
  • Treatment Outcome
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / epidemiology
  • Venous Thrombosis / drug therapy*
  • Venous Thrombosis / epidemiology
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Warfarin