Advertisement

Age over 75 does not increase the risk of recurrent venous thromboembolism: Findings from the RIETE registry

Published:December 16, 2022DOI:https://doi.org/10.1016/j.thromres.2022.12.005
      Based on current evidence, in most patients with an episode of venous thromboembolism (VTE) extended anticoagulation is generally recommended beyond the initial 3–6 months provided the bleeding risk is acceptably low [
      • Weitz J.I.
      • Prandoni P.
      • Verhamme P.
      Anticoagulation for patients with venous thromboembolism: when is extended treatment required?.
      ]. Among factors that are expected to increase the risk of (major) bleeding complications is the elderly age. In a recent overview and meta-analysis of 27 prospective cohort and randomized clinical trials, older patients were found to exhibit a higher risk of major or clinically relevant bleeding complications, even with the use of the direct oral anticoagulants (DOAC) [
      • Khan F.
      • Tritschler T.
      • Kimpton M.
      • Wells P.S.
      • Kearon C.
      • Weitz J.I.
      • Büller H.R.
      • Raskob G.E.
      • Ageno W.
      • Couturaud F.
      • Prandoni P.
      • Palareti G.
      • Legnani C.
      • Kyrle P.A.
      • Eichinger S.
      • Eischer L.
      • Becattini C.
      • Agnelli G.
      • Vedovati M.C.
      • Geersing G.J.
      • Takada T.
      • Cosmi B.
      • Aujesky D.
      • Marconi L.
      • Palla A.
      • Siragusa S.
      • Bradbury C.A.
      • Parpia S.
      • Mallick R.
      • Lensing A.W.A.
      • Gebel M.
      • Grosso M.A.
      • Thavorn K.
      • Hutton B.
      • Le Gal G.
      • Fergusson D.A.
      • Rodger M.A.
      Long-term risk for major bleeding during extended oral anticoagulant therapy for first unprovoked venous thromboembolism: a systematic review and meta-analysis.
      ]. Not surprisingly, therefore, the prolongation of anticoagulation beyond the initial 3–6 months in patients over 75 years old is generally discouraged [
      • Kearon C.
      • Akl E.A.
      • Ornelas J.
      • Blaivas A.
      • Jimenez D.
      • Bounameaux H.
      • Huisman M.
      • King C.S.
      • Morris T.A.
      • Sood N.
      • Stevens S.M.
      • Vintch J.R.
      • Wells P.
      • Woller S.C.
      • Moores L.
      Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.
      ]. This recommendation, however, can only be justified if the risk of recurrent VTE in patients in whom anticoagulation is discontinued does not exceed that expected in younger individuals. As far as we know, no study has addressed the risk of recurrent VTE beyond the age of 75. Hence, this key question is still unanswered.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Thrombosis Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Weitz J.I.
        • Prandoni P.
        • Verhamme P.
        Anticoagulation for patients with venous thromboembolism: when is extended treatment required?.
        Thromb. Haemost. Open. 2020; 4: e446-e456
        • Khan F.
        • Tritschler T.
        • Kimpton M.
        • Wells P.S.
        • Kearon C.
        • Weitz J.I.
        • Büller H.R.
        • Raskob G.E.
        • Ageno W.
        • Couturaud F.
        • Prandoni P.
        • Palareti G.
        • Legnani C.
        • Kyrle P.A.
        • Eichinger S.
        • Eischer L.
        • Becattini C.
        • Agnelli G.
        • Vedovati M.C.
        • Geersing G.J.
        • Takada T.
        • Cosmi B.
        • Aujesky D.
        • Marconi L.
        • Palla A.
        • Siragusa S.
        • Bradbury C.A.
        • Parpia S.
        • Mallick R.
        • Lensing A.W.A.
        • Gebel M.
        • Grosso M.A.
        • Thavorn K.
        • Hutton B.
        • Le Gal G.
        • Fergusson D.A.
        • Rodger M.A.
        Long-term risk for major bleeding during extended oral anticoagulant therapy for first unprovoked venous thromboembolism: a systematic review and meta-analysis.
        Ann. Intern. Med. 2021; 174: 1420-1429
        • Kearon C.
        • Akl E.A.
        • Ornelas J.
        • Blaivas A.
        • Jimenez D.
        • Bounameaux H.
        • Huisman M.
        • King C.S.
        • Morris T.A.
        • Sood N.
        • Stevens S.M.
        • Vintch J.R.
        • Wells P.
        • Woller S.C.
        • Moores L.
        Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.
        Chest. 2016; 149: 315-352
        • Bikdeli B.
        • Jimenez D.
        • Hawkins M.
        • Ortíz S.
        • Prandoni P.
        • Brenner B.
        • Decousus H.
        • Masoudi F.A.
        • Trujillo-Santos J.
        • Krumholz H.M.
        • Monreal M.
        Rationale, design and methodology of the computerized registry of patients with venous thromboembolism.
        Thromb. Haemost. 2018; 118: 214-224
        • Heit J.A.
        Venous thromboembolism: disease burden, outcomes and risk factors.
        J. Thromb. Haemost. 2005; 3: 1611-1617
        • Lauber S.
        • Limacher A.
        • Tritschler T.
        • Stalder O.
        • Méan M.
        • Righini M.
        • Aschwanden M.
        • Hans Beer J.
        • Frauchiger B.
        • Osterwalder J.
        • Kucher N.
        • Lämmle B.
        • Cornuz J.
        • Angelillo-Scherrer A.
        • Matter C.M.
        • Husmann M.
        • Banyai M.
        • Staub D.
        • Mazzolai L.
        • Hugli O.
        • Rodondi N.
        • Aujesky D.
        Predictors and outcomes of recurrent venous thromboembolism in elderly patients.
        Am. J. Med. 2018; 131: e7-703.e16
        • Campello E.
        • Simioni P.
        • Prandoni P.
        • Ferri N.
        Clinical pharmacology of factor XI inhibitors: new therapeutic approaches for prevention of venous and arterial thrombotic disorders.
        J. Clin. Med. 2022; 11: 6314
        • Andreozzi G.M.
        • Bignamini A.A.
        • Davì G.
        • Palareti G.
        • Matuška J.
        • Holý M.
        • Pawlaczyk-Gabriel K.
        • Džupina A.
        • Sokurenko G.Y.
        • Didenko Y.P.
        • Andrei L.D.
        • Lessiani G.
        • Visonà A.
        Sulodexide for the Prevention of Recurrent Venous Thromboembolism: The Sulodexide in secondary prevention of recurrent deep vein thrombosis (SURVET) study: a multicenter, randomized, double-blind, placebo-controlled trial.
        Circulation. 2015; 132: 1891-1897
        • Palareti G.
        • Legnani C.
        • Antonucci E.
        • Zorzi S.
        • Bignamini A.A.
        • Lodigiani C.
        • Tosetto A.
        • Bertù L.
        • Pengo V.
        • Testa S.
        • Ageno W.
        • Prisco D.
        • Prandoni P.
        • Poli D.
        Design and rationale of a randomized, placebo-controlled trial on the efficacy and safety of sulodexide for extended treatment in elderly patients after a first venous thromboembolism.
        Intern.Emerg. Med. 2021; 16: 359-368