Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

Sandro Lauber; Andreas Limacher; Tobias Tritschler; Odile Stalder; Marie Méan; Marc Righini; Markus Aschwanden; Jürg Hans Beer; Beat Frauchiger; Josef Osterwalder; Nils Kucher; Bernhard Lämmle; Jacques Cornuz; Anne Angelillo-Scherrer; Christian M Matter; Marc Husmann; Martin Banyai; Daniel Staub; Lucia Mazzolai; Olivier Hugli; Nicolas Rodondi; Drahomir Aujesky

doi:10.1016/j.amjmed.2017.12.015

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

Am J Med. 2018 Jun;131(6):703.e7-703.e16. doi: 10.1016/j.amjmed.2017.12.015. Epub 2018 Jan 4.

Authors

Sandro Lauber¹, Andreas Limacher², Tobias Tritschler³, Odile Stalder², Marie Méan⁴, Marc Righini⁵, Markus Aschwanden⁶, Jürg Hans Beer⁷, Beat Frauchiger⁸, Josef Osterwalder⁹, Nils Kucher¹⁰, Bernhard Lämmle¹¹, Jacques Cornuz¹², Anne Angelillo-Scherrer¹³, Christian M Matter¹⁴, Marc Husmann¹⁵, Martin Banyai¹⁶, Daniel Staub⁶, Lucia Mazzolai¹⁷, Olivier Hugli¹⁸, Nicolas Rodondi¹⁹, Drahomir Aujesky³

Affiliations

¹ Department of General internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: sandro.lauber@insel.ch.
² CTU Bern and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
³ Department of General internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Department of General internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
⁵ Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
⁶ Division of Angiology, Basel University Hospital, Basel, Switzerland.
⁷ Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
⁸ Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland.
⁹ Department of Emergency Medicine, Cantonal Hospital of St Gallen, St Gallen, Switzerland.
¹⁰ Clinic for Angiology, Zurich University Hospital, Zurich, Switzerland.
¹¹ Department of Hematology and Central Hematology Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
¹² Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland.
¹³ Department of Hematology and Central Hematology Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
¹⁴ Center for Molecular Cardiology, University of Zurich, and Clinic for Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland.
¹⁵ Division of Angiology, Zurich University Hospital and Centre for Vascular Diseases Zurich, Zurich, Switzerland.
¹⁶ Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹⁷ Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland.
¹⁸ Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
¹⁹ Department of General internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.

PMID: 29307536
DOI: 10.1016/j.amjmed.2017.12.015

Abstract

Background: Little is known about predictors and outcomes of recurrent venous thromboembolism in elderly patients.

Methods: We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was symptomatic recurrent venous thromboembolism. We explored the association between baseline characteristics and treatments and recurrent venous thromboembolism using competing risk regression, adjusting for periods of anticoagulation as a time-varying covariate. We also assessed the clinical consequences (case-fatality, localization) of recurrent venous thromboembolism.

Results: During a median follow-up period of 30 months, 122 patients developed recurrent venous thromboembolism, corresponding to a 3-year cumulative incidence of 14.8%. The case-fatality of recurrence was high (20.5%), particularly in patients with unprovoked (23%) and cancer-related venous thromboembolism (29%). After adjustment, only unprovoked venous thromboembolism (sub-hazard ratio, 1.67 compared with provoked venous thromboembolism; 95% confidence interval, 1.00-2.77) and proximal deep vein thrombosis (sub-hazard ratio, 2.41 compared with isolated distal deep vein thrombosis; 95% confidence interval, 1.07-5.38) were significantly associated with recurrence. Patients with initial pulmonary embolism were more likely to have another pulmonary embolism as a recurrent event than patients with deep vein thrombosis.

Conclusions: Elderly patients with acute venous thromboembolism have a substantial long-term risk of recurrent venous thromboembolism, and recurrence carries a high case-fatality rate. Only 2 factors, unprovoked venous thromboembolism and proximal deep vein thrombosis, were independently associated with recurrent venous thromboembolism, indicating that traditional risk factors for venous thromboembolism recurrence (eg, cancer) may be less relevant in the elderly.

Trial registration: ClinicalTrials.gov NCT00973596.

Keywords: Elderly; Recurrence; Venous thromboembolism.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Recurrence
Risk Factors
Switzerland / epidemiology
Venous Thromboembolism / epidemiology
Venous Thromboembolism / etiology*
Venous Thromboembolism / mortality
Venous Thromboembolism / pathology*

Associated data

ClinicalTrials.gov/NCT00973596