Outcome of Elderly Patients with Venous Thromboembolism Treated with Direct Oral Anticoagulants—A Retrospective Cohort Study

Ayalon-Dangur, Irit; Vega, Yakov; Israel, Miriam Rozi; Grossman, Alon; Spectre, Galia; Shochat, Tzippy; Leibovici, Leonard; Gafter‐Gvili, Anat

doi:10.3390/jcm10235673

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…Furthermore, cohorts of elderly people undergoing acute treatment for VTE with DOACs point to conflicting results regarding the risk of VTE recurrence. [28][29][30] Given that DOACs have a quicker offset of action than VKA, compliance with them is crucial. Compared to younger patients, older people may have more compliance problems.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials

Pessôa,

Kessler,

Becker

et al. 2024

Vasc Endovascular Surg

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Objective This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in adults aged 75 and over undergoing acute venous thromboembolism (VTE) treatment. Methods PubMed, Embase and the CENTRAL were searched up to 25 December 2023. The incidence of VTE recurrence and bleeding events was assessed. Employing a frequentist network meta-analysis approach, interventions not directly compared could be indirectly assessed through the 95% confidence interval (CI), enhancing the interpretability of the search results. The surface under the cumulative ranking curves (SUCRA) was utilized to generate the relative ranking probabilities for each group. Results Our study, analysing 6 randomised controlled trials with 3665 patients, compares direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in adults aged 75 and over with acute venous thromboembolism. Edoxaban reduces VTE recurrence risk compared with VKAs (risk ratio [RR] .50, 95% CI 0.27 – .95), while apixaban significantly decreases bleeding risk compared with VKAs (RR .23, 95% CI 0.08 – .69), edoxaban (RR .28, 95% CI 0.09 – .86) and rivaroxaban (RR .28, 95% CI 0.09 – .86). Despite low overall evidence quality, apixaban consistently ranks highest for both efficacy and safety. Findings underscore the nuanced efficacy-safety balance in this population, emphasizing cautious interpretation due to evidence limitations. Conclusion Apixaban emerges as a favourable choice for acute VTE treatment in the elderly, displaying reduced bleeding risk compared to other treatments while maintaining comparable efficacy. Future studies should explore diverse anticoagulants efficacy and safety in older populations. Additionally, clinical prediction models tailored to geriatric cohorts are crucial for guiding treatment duration decisions.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials

Pessôa,

Kessler,

Becker

et al. 2024

Vasc Endovascular Surg

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“…The use of NOACs in elderly patients is associated with a lower risk of bleeding with the same efficacy as VKA. The possibility of using lower doses of NOACs in this population should be considered in view of the presence of many comorbidities [139].…”

Section: Treatment Of Pe In Elderly Patientsmentioning

confidence: 99%

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Lasica¹,

Ašanin²,

Djukanovic³

et al. 2022

Preprint

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Pulmonary thromboembolism is a very common cardiovascular disease, with a still high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. Heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decision on the therapeutic regimen also represents a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate-high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except for certain categories of patients (patients with antiphospholipid syndrome, mechanical valves, pregnancy). When using oral anticoagulant therapy, special attention should be paid to drug-drug interactions, which can lead to many complications, even to the death of the patient. Special population groups such as pregnant women, obese patients, patients with antiphospholipid syndrome and cancer represent a great therapeutic challenge in the application of anticoagulant therapy. In these patients, not only the effectiveness of the drugs must be taken into account, but great attention must be paid to their safety and possible side effects, which is why a multidisciplinary approach is emphasized in order to provide the best therapeutic option.

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“…Clinicians may treat old patients based on general guidelines and their own experience with uncertainty. There have been several studies focusing on patients with pulmonary embolism over 65 years [ 9 – 14 ]. Data on clinical characteristics, management and outcome of PE in very old patients is limited.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism: a multicenter study report

Zhou,

Yang,

Zhai

et al. 2024

BMC Pulm Med

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Background Clinical characteristics of patients with pulmonary thromboembolism have been described in previous studies. Although very old patients with pulmonary thromboembolism are a special group based on comorbidities and age, they do not receive special attention. Objective This study aims to explore the clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism in a relatively large population. Design and participants The study included a total of 7438 patients from a national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES). Consecutive patients with acute pulmonary thromboembolism were enrolled and were divided into three groups. Comparisons were performed between these three groups in terms of clinical characteristics, comorbidities and in-hospital prognosis. Mortality predictors were analyzed in very old patients with pulmonary embolism. Key results In 7,438 patients with acute pulmonary thromboembolism, 609 patients aged equal to or greater than 80 years (male 354 (58.1%)). There were 2743 patients aged between 65 and 79 years (male 1313 (48%)) and 4095 patients aged younger than 65 years (male 2272 (55.5%)). Patients with advanced age had significantly more comorbidities and worse condition, however, some predisposing factors were more obvious in younger patients with pulmonary thromboembolism. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2, malignancy, anticoagulation as first therapy were mortality predictors for all-cause death in very old patients with pulmonary thromboembolism. The analysis found that younger patients were more likely to have chest pain, hemoptysis (the difference was statistically significant) and dyspnea triad. Conclusion In very old population diagnosed with pulmonary thromboembolism, worse laboratory results, atypical symptoms and physical signs were common. Mortality was very high and comorbid conditions were their features compared to younger patients. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2 and malignancy were positive mortality predictors for all-cause death in very old patients with pulmonary thromboembolism while anticoagulation as first therapy was negative mortality predictors.

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Outcome of Elderly Patients with Venous Thromboembolism Treated with Direct Oral Anticoagulants—A Retrospective Cohort Study

Cited by 5 publications

References 33 publications

Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials

Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

Clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism: a multicenter study report

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