Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism.
Details
State: Public
Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_BB8DC8C1A571
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism.
Journal
Research and practice in thrombosis and haemostasis
Working group(s)
RIETE Investigators
Contributor(s)
Decousus H., Prandoni P., Brenner B., Barba R., Bertoletti L., Tzoran I., Reis A., Bosevski M., Bounameaux H., Malý R., Wells P., Papadakis M., Adarraga M.D., Agudo P., Aibar M.A., Alfonso M., Arcelus J.I., Ballaz A., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Cañas I., Casado I., Chic N., Del Pozo R., Del Toro J., Díaz-Pedroche M.C., Díaz-Peromingo J.A., Falgá C., Fernández-Aracil C., Fernández-Capitán C., Fidalgo M.A., Font C., Font L., Gallego P., García M.A., García-Bragado F., Gavín O., Gómez C., Gómez V., González J., Grau E., Grimón A., Guijarro R., Guirado L., Gutiérrez J., Hernández-Comes G., Hernández-Blasco L., Jara-Palomares L., Jaras M.J., Jiménez D., Jiménez J., Joya M.D., Llamas P., Lobo J.L., López P., López-Jiménez L., López-Reyes R., López-Sáez J.B., Lorente M.A., Lumbierres M., Luque J.M., Marchena P.J., Martín-Martos F., Mellado M., Nieto S., Núñez A., Núñez M.J., Otalora S., Otero R., Pedrajas J.M., Pérez G., Pérez-Ductor C., Peris M.L., Pons I., Porras J.A., Reig O., Riera-Mestre A., Riesco D., Rivas A., Rodríguez M., Rodríguez-Dávila M.A., Rosa V., Rosillo-Hernández E., Ruiz-Artacho P., Ruiz-Giménez N., Sahuquillo J.C., Sala-Sainz M.C., Sánchez-Martínez R., Sanz O., Soler S., Sopeña B., Suriñach J.M., Tolosa C., Torres M.I., Troya J., Trujillo-Santos J., Uresandi F., Usandizaga E., Valle R., Vela J., Vela L., Vicente M.P., Xifre B., Vanassche T., Verhamme P., Yoo H., Wells P., Hirmerova J., Malý R., Dulíček P., Salgado E., Bertoletti L., Bura-Riviere A., Farge-Bancel D., Hij A., Mahé I., Merah A., Braester A., Brenner B., Tzoran I., Antonucci G., Barillari G., Bilora F., Bortoluzzi C., Brandolin B., Cattabiani C., Ciammaichella M., Dell'Elce N., Dentali F., Duce R., Grandone E., Imbalzano E., Lessiani G., Maida R., Mastroiacovo D., Pace F., Parisi R., Pellegrinet M., Pesavento R., Pinelli M., Poggio R., Prandoni P., Quintavalla R., Rocci A., Tiraferri E., Tonello D., Tufano A., Visonà A., Gibietis V., Skride A., Vitola B., Bosevski M., Zdraveska M., Bounameaux H., Mazzolai L.
ISSN
2475-0379 (Electronic)
ISSN-L
2475-0379
Publication state
Published
Issued date
10/2017
Peer-reviewed
Oui
Volume
1
Number
2
Pages
172-179
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
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.
To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non-fragile patients with VTE.
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.
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.
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.
To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non-fragile patients with VTE.
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.
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.
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.
Keywords
anticoagulants, hemorrhage, mortality, recurrences, venous thromboembolism
Pubmed
Open Access
Yes
Create date
12/10/2018 13:04
Last modification date
20/08/2019 15:29
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