Anticoagulation quality and clinical outcomes in multimorbid elderly patients with acute venous thromboembolism.

Lange, Naomi; Méan, Marie; Stalder, Odile; Limacher, Andreas; Tritschler, Tobias; Rodondi, Nicolas; Aujesky, Drahomir (2019). Anticoagulation quality and clinical outcomes in multimorbid elderly patients with acute venous thromboembolism. Thrombosis research, 177, pp. 10-16. Elsevier 10.1016/j.thromres.2019.02.017

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BACKGROUND Multimorbid patients with acute venous thromboembolism (VTE) are often excluded from clinical trials and little is known about their prognosis. OBJECTIVES To examine whether multimorbidity is associated with adverse clinical outcomes and lower anticoagulation quality in older patients with VTE. PATIENTS/METHODS We studied 991 patients aged ≥65 years with acute VTE in a Swiss prospective multicenter cohort study. A modified Charlson Comorbidity Index was used to measure multimorbidity, which was defined as the presence ≥2 of 17 predefined comorbid conditions. We examined the association between multimorbidity and recurrent VTE and major bleeding, adjusting for confounders and periods of anticoagulation. We assessed whether the percentage of time spent in the therapeutic international normalized ratio (INR) range varied by the number of comorbidities present. RESULTS Overall, 708 (71%) patients were multimorbid. Multimorbid patients had a higher 3-year cumulative incidence of recurrent VTE (16.8 vs. 10.8%; P = 0.056) and major bleeding (18.7 vs. 9.0%; P = 0.001) than non-multimorbid patients. After adjustment, multimorbid patients had a significantly higher risk of recurrent VTE (sub-hazard ratio [SHR] 1.66, 95% confidence interval [CI] 1.08-2.57) and a higher risk of major bleeding (SHR 1.55, 95% CI 0.96-2.50), although the latter failed to achieve statistical significance. With increasing numbers of comorbid conditions, patients spent less time in and more time above and below the therapeutic INR range. CONCLUSIONS Multimorbid patients with acute VTE have not only a lower anticoagulation quality but also more complications. Clinical trials should explicitly enroll multimorbid patients to determine the optimal anticoagulation strategy in such patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Lange, Franziska Naomi; Méan Pascual, Marie; Stalder, Odile; Limacher, Andreas; Tritschler, Tobias; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0049-3848

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

06 Mar 2019 09:07

Last Modified:

06 Mar 2019 09:33

Publisher DOI:

10.1016/j.thromres.2019.02.017

PubMed ID:

30826719

Uncontrolled Keywords:

Deep vein thrombosis Pulmonary embolism Risk factors

BORIS DOI:

10.7892/boris.127592

URI:

https://boris.unibe.ch/id/eprint/127592

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