Abstract
Background
The natural history of venous thromboembolism (VTE) in patients with dementia has
not been thoroughly studied.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: February 29, 2012
Accepted:
February 6,
2012
Received in revised form:
December 23,
2011
Received:
December 23,
2011
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
