Venous thromboembolism in immobilized patients with dementia. Findings from the RIETE registry

Published:February 29, 2012DOI:



      The natural history of venous thromboembolism (VTE) in patients with dementia has not been thoroughly studied.


      We used the RIETE Registry data to assess the clinical characteristics, treatment strategies and outcome during the first 3 months after acute VTE in all immobilized patients with dementia.


      As of August 2011, 37988 patients had been enrolled, of whom 1316 (3.5%) had dementia. Most patients in both subgroups were initially treated with low-molecular-weight heparin (LMWH). Then, 48% of patients with dementia and 25% of those without dementia received LMWH as long-term therapy. During the first 3 months of anticoagulant therapy, patients with dementia had a higher incidence of fatal pulmonary embolism (PE): 4.0% vs. 1.2% (odds ratio: 3.3; 95% CI: 2.5-4.4) and fatal bleeding: 1.4% vs. 0.5% (odds ratio: 2.9; 95% CI: 1.8-4.6) than those without dementia. In demented patients initially presenting with PE, the incidence of fatal PE during the first week outweighed that of fatal bleeding (42 vs. 4 deaths), but from Day 8, the incidence of fatal PE was similar to the incidence of fatal bleeding. In patients initially presenting with deep vein thrombosis (DVT), there were 4 fatal PE and 8 fatal bleeding events.


      VTE patients with dementia had a high incidence of fatal PE and fatal bleeding. In those initially presenting with PE, the risk of dying of PE far outweighed that of fatal bleeding. In patients presenting with DVT alone, the risk of fatal PE was lower than that of fatal bleeding.


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        • Agüero-Torres H.
        • Fratiglioni L.
        • Guo Z.
        • Viitanen M.
        • Winblad B.
        Mortality from dementia in advanced age: a 5-year follow-up study of incident dementia cases.
        J Clin Epidemiol. 1999; 52: 737-743
        • Helmer C.
        • Joly P.
        • Letenneur L.
        • Commenges D.
        • Dartigues J.F.
        Mortality with dementia: Results from a French prospective community-based cohort.
        Am J Epidemiol. 2001; 154: 642-648
        • Fitzpatrick A.L.
        • Kuller L.H.
        • Lopez O.L.
        • Kawas C.H.
        • Jagust W.
        Survival following dementia onset: Alzheimer's disease and vascular dementia.
        J Neurol Sci. 2005; 230: 43-49
        • Mitchell S.L.
        • Teno J.M.
        • Kiely D.K.
        • Shaffer M.L.
        • Jones R.N.
        • Prigerson H.G.
        • et al.
        The clinical course of advanced dementia.
        N Engl J Med. 2009; 361: 1529-1538
        • Kammoun S.
        • Gold G.
        • Bouras C.
        • Giannakapoulos P.
        • McGee W.
        • Herrmann F.
        • et al.
        Immediate causes of death of demented and non-demented elderly.
        Acta Neurol Scand. 2000; : 96-99
        • Brunnström H.R.
        • Englund E.M.
        Cause of death in patients with dementia disorders.
        Eur J Neurol. 2009; 16: 488-492
        • Fu C.
        • Chute D.J.
        • Farag E.S.
        • Garakian J.
        • Cummings J.L.
        • Vinters H.V.
        Co-morbidity in dementia. An autopsy study.
        Arch Pathol Lab Med. 2004; 128: 32-38
        • Robert-Ebadi H.
        • Le Gal G.
        • Righini M.
        Use of anticoagulants in elderly patients: practical recommendations.
        Clin Interv Aging. 2009; 4: 165-177
        • Kearon C.
        • Kahn S.
        • Agnelli G.
        • Goldhaber S.
        • Raskob G.E.
        • Comerota A.J.
        Antithrombotic therapy for venous thromboembolic disease. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2008; 133 (8th Edition): 454S-545S
        • Ruiz-Giménez N.
        • Suárez C.
        • González R.
        • Nieto J.A.
        • Todolí J.A.
        • Samperiz A.L.
        • et al.
        Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry.
        Thromb Haemost. 2008; 100: 26-31
        • Nieto J.A.
        • Solano R.
        • Ruiz-Ribó M.D.
        • Ruiz-Giménez N.
        • Prandoni P.
        • Kearon C.
        • et al.
        Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: Findings from the RIETE Registry.
        J Thromb Haemost. 2010; 8: 1216-1222
        • López-Jiménez L.
        • Montero M.
        • González-Fajardo J.A.
        • Arcelus J.I.
        • Suárez C.
        • Lobo J.L.
        • et al.
        Venous thromboembolism in very elderly patients: Findings from a prospective registry (RIETE).
        Haematologica. 2006; 91: 1046-1051
        • Laporte S.
        • Mismetti P.
        • Décousus H.
        • Uresandi F.
        • Otero R.
        • Lobo J.L.
        • et al.
        Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism; Findings from the registro informatizado de la enfermedad tromboembólica venosa (RIETE) Registry.
        Circulation. 2008; 117: 1711-1716
        • Sánchez Muñoz-Torrero J.F.
        • Bounameaux H.
        • Pedrajas J.M.
        • Lorenzo A.
        • Rubio S.
        • Kearon C.
        • et al.
        Effects of age on the risk of dying from pulmonary embolismo or bleeding Turing treatment of deep vein trombosis.
        J Vasc Surg. 2011; 54: 26S-32S
        • Vasco B.
        • Villalba J.C.
        • Lopez-Jimenez L.
        • Falgá C.
        • Montes J.
        • Trujillo-Santos J.
        • et al.
        Venous thromboembolism in nonagenarians. Findings from the RIETE Registry.
        Thromb Haemost. 2009; 101: 1112-1118
        • Lecumberri R.
        • Soler S.
        • Del Toro J.
        • Barba R.
        • Rosa V.
        Ciammaichella MM.
        Monreal M. Effect of the time of diagnosis on outcome in patients with acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost. 2011; 105: 45-51
        • Pini M.
        • Aiello S.
        • Manotti C.
        • Pattacini C.
        • Quintavalla R.
        • Poli T.
        • et al.
        Low molecular weight heparin versus warfarin in the prevention of recurrences after deep vein thrombosis.
        Thromb Haemost. 1994; 72: 191-197
        • Das S.K.
        • Cohen A.T.
        • Edmonson R.A.
        • Melissari M.D.
        • Kakkar V.V.
        Low-molecular-weight heparin versus warfarin for prevention of recurrent venous thromboembolism: a randomized trial.
        World J Surg. 1996; 20: 521-527
        • Lopaciuk S.
        • Bielska-Falda H.
        • Noszczyk W.
        • Bielawiec M.
        • Witkiewicz W.
        • Filipecki S.
        • et al.
        Low molecular weight heparin versus acenocoumarol in the secondary prophylaxis of deep vein thrombosis.
        Thromb Haemost. 1999; 81: 26-31
        • Gonzalez-Fajardo J.
        • Arreba W.
        • Castrodeza J.
        • Perez J.L.
        • Fernández L.
        • Agundez I.
        • et al.
        Venographic comparison of subcutaneous low-molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep vein thrombosis.
        J Vasc Surg. 1999; 30: 283-292
        • Veiga F.
        • Escriba A.
        • Maluenda M.
        • López Rubio M.
        • Margalet I.
        • Lezana A.
        • et al.
        Low molecular weight heparin (enoxaparin) versus oral anticoagulant therapy (acenocoumarol) in the long-term treatment of deep vein thrombosis in the elderly: a randomized trial.
        Thromb Haemost. 2000; 84: 559-564
        • Hull R.D.
        • Pineo G.F.
        • Brant R.F.
        • Mah A.F.
        • Burke N.
        • Dear R.
        • et al.
        LITE Trial Investigators. Long-term low molecular weight heparin versus usual care in proximal deep vein thrombosis patients with cancer.
        Am J Med. 2006; 119: 1062-1072
        • Iorio A.
        • Guercini F.
        • Pini M.
        Low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants.
        J Thromb Haemost. 2003; 1: 1906-1913
        • Harris D.
        Forget me not: palliative care for people with dementia.
        Postgrad Med J. 2007; 83: 362-366
        • Lee M.
        • Chodosh J.
        Dementia and life expectancy: What do we know?.
        J Am Med Dir Assoc. 2009; 10: 466-471
        • Sachs G.A.
        Dying from dementia.
        N Engl J Med. 2009; 361: 1595-1596
        • Heath I.
        What do we want to die from? Continuing to fight all causes of mortality offers no hope of success.
        Br Med J. 2010; 341: 181