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Venous Thromboembolism in Older Adults: A Community-based Study.
Am J Med. 2014 Feb 18;
Authors: Spencer FA, Gurwitz JH, Schulman S, Linkins LA, Crowther MA, Ginsberg JS, Lee AY, Saczynski JS, Anand S, Lessard D, Emery C, Huang W, Goldberg RJ
Abstract
BACKGROUND: While the incidence of venous thromboembolism increases with age, little is known about its contemporary management or outcomes in older patients. Our goal was to compare the characteristics, treatment, and outcomes associated with venous thromboembolism, in patients aged 65-69 years, 70-74 years, 75-79 years, and 80+ years. Methods/Participants: We prospectively followed 542 subjects age ≥65 years with venous thromboembolism from January 2008 till August 2011 at 6 sites. In addition, a retrospective study of 681 additional subjects age ≥65 years with venous thromboembolism diagnosed in 2007 and 2009 was conducted at the same six sites.
RESULTS: With advancing age, patients were more likely to suffer provoked venous thromboembolism but less likely to present with pulmonary embolism. Patients with unprovoked, provoked, or malignancy associated venous thromboembolism received warfarin for a median of 401 days, 203 days, and 529 days, respectively. Age ≥ 80 years was not associated with an increased risk of recurrent venous thromboembolism but there was an increased risk of all-cause mortality.
CONCLUSION: With advancing age, patients are more likely to suffer hospital-associated and provoked venous thromboembolism. Many elderly patients with provoked or unprovoked venous thromboembolism were treated for >3 months or >12 months, respectively. Given that advanced age was not associated with increased risk of recurrent venous thromboembolism but elderly patients in general have a higher risk of bleeding from continued anticoagulant therapy, such practice is potentially harmful. At the same time such argument could be used to more vigorously offer prophylaxis in the first place.
PMID: 24561112 [PubMed - as supplied by publisher]