Subject: anticoagulants
Subject: hemorrhage
Subject: mortality
Subject: mortality
Subject: recurrences
Subject: venous thromboembolism
Year: 2017
Type: Article
Title: Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism.
Author: Moustafa F
Author: Giorgi Pierfranceschi M
Author: Di Micco P
Author: Bucherini E
Author: Lorenzo A
Author: Villalobos A
Author: Nieto JA
Author: Valero B
Author: Sampériz ÁL
Author: Monreal M
Author: RIETE Investigators
Author: Bosevski M
Author: Zdraveska M
Abstract: Background Subgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet. Objectives To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE. Methods Retrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg. Results From January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile. Conclusions In real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.
Publisher:
Relation: Research and Practactice in Thrombosis and Haemostasis
Identifier: oai:repository.ukim.mk:20.500.12188/29206
Identifier: Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism. Res Pract Thromb Haemost. 2017 Sep 4;1(2):172-179.
Identifier: http://hdl.handle.net/20.500.12188/29206Identifier: 10.1002/rth2.12036
