Age-Related Differences in the Presentation, Management, and Clinical Outcomes of 100,000 Patients With Venous Thromboembolism in the RIETE Registry

Ortega, Alberto García; Jiménez, David; Pedro-Tudela, Ana; Pérez-Ductor, Cristina; Fernández-Capitán, Carmen; Falgá, Conxita; Skride, Andris; Siniscalchi, Carmine; Weinberg, Ido; Monreal, Manuel

doi:10.1016/j.arbres.2023.12.016

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and basic research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Vol. 60. Issue 3.

Pages 143-152 (March 2024)

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Vol. 60. Issue 3.

Pages 143-152 (March 2024)

Original Article

DOI: 10.1016/j.arbres.2023.12.016

Age-Related Differences in the Presentation, Management, and Clinical Outcomes of 100,000 Patients With Venous Thromboembolism in the RIETE Registry

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Alberto García Ortegaa,b,

Corresponding author

albortgva@gmail.com

Corresponding author.

, David Jiménezc,d,e, Ana Pedro-Tudelaa, Cristina Pérez-Ductorf, Carmen Fernández-Capitáng, Conxita Falgáh, Andris Skridei, Carmine Siniscalchij, Ido Weinbergk, Manuel Monreald,l, the RIETE investigators ◊

a Respiratory Department, Hospital Dr. Peset, Valencia, Spain

b Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain

c Respiratory Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain

d CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

e Medicine Department, Universidad de Alcalá, Madrid, Spain

f Emergency Department, Hospital Dr. Peset, Valencia, Spain

g Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain

h Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain

i Department of Cardiology, Ospedale Pauls Stradins Clinical University Hospital, Riga Stradiņš University, Riga, Latvia

j Department of Angiology, Azienda Ospedaliera Universitaria, Parma, Italy

k Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA

l Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM – Universidad Católica San Antonio de Murcia, Spain

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Tables (6)

Table 1. Clinical characteristics at baseline in the first 100,000 patients with acute VTE enrolled in the RIETE registry, according to age.

Table 2. Initial VTE presentation in the first 100,000 patients recruited in the RIETE registry, according to age.

Table 3. Treatment strategies for initial and long-term anticoagulant therapy in the first 100,000 patients in the RIETE registry, according to age.

Table 4. Thirty- and ninety-day outcomes in the first 100,000 patients in the RIETE registry, according to age.

Table 5. Multivariable model of predictors of 30-day all-cause mortality*.

Table 6. Thirty- and ninety-day outcomes in patients with acute pulmonary embolism (N=49,202) in the RIETE registry, according to age.

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Abstract

Introduction

Although older adults represent a significant proportion of patients with venous thromboembolism (VTE), the data on the impact of age-related differences in the clinical presentation, management, and outcomes of VTE are scarce.

Methods

We analyzed data from the RIETE registry database, an ongoing global observational registry of patients with objectively confirmed VTE, to compare patient characteristics, clinical presentation, treatments, and outcomes between elderly (≥70 years) vs. non-elderly (<70 years) patients.

Results

From January 2001 to March 2021, 100,000 adult patients were enrolled in RIETE. Elderly patients (47.9%) were more frequently women (58.2% vs. 43.5%), more likely had unprovoked VTE (50.5% vs. 45.1%) and most often presented with severe renal failure (10.2% vs. 1.2%) and acute pulmonary embolism (PE) (vs. deep vein thrombosis) (54.3% vs. 44.5%) compared to non-elderly patients (p<0.001 for all comparisons). For the PE subgroup, elderly patients more frequently had non-low risk PE (78.9% vs. 50.7%; p<0.001), respiratory failure (33.9% vs. 21.8%; p<0.001) and myocardial injury (40.0% vs. 26.2%; p<0.001) compared to non-elderly patients. Thrombolysis (0.9% vs. 1.7%; p<0.001) and direct oral anticoagulants (8.8% vs. 11.8%; p<0.001) were less frequently administered to elderly patients. Elderly patients showed a significantly higher 30-day all-cause mortality (adjusted odds ratio [OR] 1.36, 95%CI: 1.22–1.52) and major bleeding (OR, 2.08; 95%CI, 1.85–2.33), but a lower risk of 30-day VTE recurrences (OR, 0.62, 95%CI, 0.54–0.71).

Conclusions

Compared with non-elderly patients, elderly patients had a different VTE clinical profile. Advanced therapies were less frequently used in older patients. Age was an independent predictor of mortality.

Keywords:

Pulmonary embolism

Venous thromboembolism

Anticoagulation

Mortality

Bleeding

Recurrences

Abbreviations:

DVT

DOAC

ECMO

IVC