Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism. Issue 2 (4th September 2017)

• Record Type: Journal Article
• Authors: Moustafa, Farès; Giorgi Pierfranceschi, Matteo; Di Micco, Pierpaolo; Bucherini, Eugenio; Lorenzo, Alicia; Villalobos, Aurora; Nieto, José A.; Valero, Beatriz; Sampériz, Ángel L.; Monreal, Manuel
• Other Names: Decousus Hervé investigator.; Prandoni Paolo investigator.; Brenner Benjamin investigator.; Barba Raquel investigator.; Bertoletti Laurent investigator.; Tzoran Inna investigator.; Reis Abilio investigator.; Bosevski Marijan investigator.; Bounameaux Henri investigator.; Malý Radovan investigator.; Wells Philip investigator.; Papadakis Manolis investigator.; Adarraga MD investigator.; Agudo P investigator.; Aibar MA investigator.; Alfonso M investigator.; Arcelus JI investigator.; Ballaz A investigator.; Barba R investigator.; Barrón M investigator.; Barrón‐Andrés B investigator.; Bascuñana J investigator.; Blanco‐Molina A investigator.; Cañas I investigator.; Casado I investigator.; Chic N investigator.; del Pozo R investigator.; del Toro J investigator.; Díaz‐Pedroche MC investigator.; Díaz‐Peromingo JA investigator.; Falgá C investigator.; Fernández‐Aracil C investigator.; Fernández‐Capitán C investigator.; Fidalgo MA investigator.; Font C investigator.; Font L investigator.; Gallego P investigator.; García MA investigator.; García‐Bragado F investigator.; Gavín O investigator.; Gómez C investigator.; Gómez V investigator.; González J investigator.; Grau E investigator.; Grimón A investigator.; Guijarro R investigator.; Guirado L investigator.; Gutiérrez J investigator.; Hernández‐Comes G investigator.; Hernández‐Blasco L investigator.; Jara‐Palomares L investigator.; Jaras MJ investigator.; Jiménez D investigator.; Jiménez J investigator.; Joya MD investigator.; Llamas P investigator.; Lobo JL investigator.; López P investigator.; López‐Jiménez L investigator.; López‐Reyes R investigator.; López‐Sáez JB investigator.; Lorente MA investigator.; Lumbierres M investigator.; Luque JM investigator.; Marchena PJ investigator.; Martín‐Martos F investigator.; Mellado M investigator.; Nieto S investigator.; Núñez A investigator.; Núñez MJ investigator.; Otalora S investigator.; Otero R investigator.; Pedrajas JM investigator.; Pérez G investigator.; Pérez‐Ductor C investigator.; Peris ML investigator.; Pons I investigator.; Porras JA investigator.; Reig O investigator.; Riera‐Mestre A investigator.; Riesco D investigator.; Rivas A investigator.; Rodríguez M investigator.; Rodríguez‐Dávila MA investigator.; Rosa V investigator.; Rosillo‐Hernández E investigator.; Ruiz‐Artacho P investigator.; Ruiz‐Giménez N investigator.; Sahuquillo JC investigator.; Sala‐Sainz MC investigator.; Sánchez‐Martínez R investigator.; Sanz O investigator.; Soler S investigator.; Sopeña B investigator.; Suriñach JM investigator.; Tolosa C investigator.; Torres MI investigator.; Troya J investigator.; Trujillo‐Santos J investigator.; Uresandi F investigator.; Usandizaga E investigator.; Valle R investigator.; Vela J investigator.; Vela L investigator.; Vicente MP investigator.; Xifre B investigator.; Vanassche T investigator.; Verhamme P investigator.; Yoo HHB investigator.; Wells P investigator.; Hirmerova J investigator.; Malý R investigator.; Dulíček P investigator.; Salgado E investigator.; Bertoletti L investigator.; Bura‐Riviere A investigator.; Farge‐Bancel D investigator.; Hij A investigator.; Mahé I investigator.; Merah A investigator.; Braester A investigator.; Brenner B investigator.; Tzoran I investigator.; Antonucci G investigator.; Barillari G investigator.; Bilora F investigator.; Bortoluzzi C investigator.; Brandolin B investigator.; Cattabiani C investigator.; Ciammaichella M investigator.; Dell'Elce N investigator.; Dentali F investigator.; Duce R investigator.; Grandone E investigator.; Imbalzano E investigator.; Lessiani G investigator.; Maida R investigator.; Mastroiacovo D investigator.; Pace F investigator.; Parisi R investigator.; Pellegrinet M investigator.; Pesavento R investigator.; Pinelli M investigator.; Poggio R investigator.; Prandoni P investigator.; Quintavalla R investigator.; Rocci A investigator.; Tiraferri E investigator.; Tonello D investigator.; Tufano A investigator.; Visonà A investigator.; Gibietis V investigator.; Skride A investigator.; Vitola B investigator.; Bosevski M investigator.; Zdraveska M investigator.; Bounameaux H investigator.; Mazzolai L investigator.;
• Is Part Of: Research and practice in thrombosis and haemostasis. Volume 1:Issue 2(2017)
• Page Start: 172
• Page End: 179
• Publication Date: 2017-09-04
• Subjects: anticoagulants -- hemorrhage -- mortality -- recurrences -- venous thromboembolism; Thrombosis -- Periodicals; Hemostasis -- Periodicals; 616.135005
• DOI: 10.1002/rth2.12036
• Languages: English
• ISSNs: 2475-0379

Abstract

Abstract: Essentials Recent randomized trials suggested fewer bleeding events in fragile patients with VTE receiving DOACs. The frequency, clinical characteristics and outcome of these patients have not been reported in real life. Fragile patients with VTE had a higher risk for major bleeding or death and a lower risk for recurrences than non‐fragile. 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.