Thrombophilia and outcomes of venous thromboembolism in older patients

Marie Méan; Neal Breakey; Odile Stalder; Lorenzo Alberio; Andreas Limacher; Anne Angelillo-Scherrer; Pierre Fontana; Hans Jürg Beer; Nicolas Rodondi; Drahomir Aujesky; Bernhard Lämmle; Robert Escher

doi:10.1016/j.rpth.2022.100015

Thrombophilia and outcomes of venous thromboembolism in older patients

Res Pract Thromb Haemost. 2022 Dec 16;7(1):100015. doi: 10.1016/j.rpth.2022.100015. eCollection 2023 Jan.

Authors

Marie Méan¹, Neal Breakey², Odile Stalder³, Lorenzo Alberio⁴, Andreas Limacher³, Anne Angelillo-Scherrer^{5

6}, Pierre Fontana⁷, Hans Jürg Beer⁸, Nicolas Rodondi^{9

10}, Drahomir Aujesky⁹, Bernhard Lämmle^{5

11

12}, Robert Escher²

Affiliations

¹ Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
² Department of Internal Medicine, Spital Emmental, Burgdorf, Switzerland.
³ CTU Bern, University of Bern, Bern, Switzerland.
⁴ Service and Central Laboratory of Hematology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Departement of BioMedical Research, University of Bern, Bern, Switzerland.
⁷ Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland.
⁸ Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
⁹ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁰ Institute of Primary Health Care, University of Bern, Bern, Switzerland.
¹¹ Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
¹² Haemostasis Research Unit, University College London, UK.

Abstract

Background: Limited data exist on thrombophilic risk factors and clinical outcomes in the elderly with venous thromboembolism (VTE).

Objectives: To describe the prevalence of laboratory thrombophilic risk factors and their association with VTE recurrence or death in a cohort of elderly people with VTE.

Methods: In 240 patients aged ≥65 years with acute VTE without active cancer or an indication for extended anticoagulation, we performed laboratory thrombophilia testing 1 year after the index VTE. Recurrence or death was assessed during the 2-year follow-up.

Results: A total of 78% of patients had ≥1 laboratory thrombophilic risk factor(s). Elevated levels of von Willebrand factor, homocysteine, coagulant activity of factor VIII (FVIII:C), fibrinogen, FIX:C, and low antithrombin activity were the most prevalent risk factors (43%, 30%, 15%, 14%, 13%, and 11%, respectively). Additionally, 16.2% of patients experienced VTE recurrence and 5.8% of patients died. Patients with a von Willebrand factor of >182%, FVIII:C level >200%, homocysteine level >15μmol/L, or lupus anticoagulant had a significantly higher rate of recurrence than those without these risk factors (15.0 vs. 6.1 [P = .006], 23.5 vs. 8.2 [P = .01], 17.0 vs. 6.8 [P = .006], and 89.5 vs. 9.2 [P = .02] events per 100 patient-years, respectively). Furthermore, patients with a high fibrinogen level or hyperhomocysteinemia with a homocysteine level ≥30 μmol/L had significantly higher mortality than patients with normal levels (18.5 vs. 2.8 [P = .049] and 13.6 vs. 2 [P = .002] deaths per 100 patient-years, respectively). After adjustments for relevant confounders, these associations remained unchanged.

Conclusion: Laboratory thrombophilic risk factors are common in elderly people with VTE and allow for the identification of a population at the risk of worse clinical outcomes.

Keywords: blood coagulation disorders; elderly; recurrence; thrombophilia; venous thromboembolism.