Clinical characteristics of elderly patients with pulmonary embolism and risk factors for recurrence

Abstract

Introduction: Elderly patients are at increased risk for pulmonary embolism (PE) and recurrence. Aim: To define clinical characteristics of elderly PE patients and risk factors for recurrence. Method: We retrospectively analysed PE patients aged 75 and over between 2010 and 2015. Results: There were 73 patients. Main risk factors for PE were:bedridden (24.6%), recent hospitalization (13.7%), active cancer (12.3%), recent surgery (5.4%) and previous deep vein thrombosis (DVT) history (6.8%). In hospital mortality was 2.7% (2 patients). One patient with previous multiple myeloma who was entubated due to respiratory failure and other patient died during catheter directed thrombolysis. Forty patients (56.3%) were discharged with warfarin, 30 (42.3%) with low molecular heparin and one with rivaroxaban. There wasn9t any in hospital bleeding. After discharge 5 patients (6.8%) had bleeding (3 epistaxis, 1 hematuria and 1 gastrointestinal). Patient with gastrointestinal bleeding died. Others didn9t need interventional procedures for bleeding. Eleven PE and 5 previous DVT total 16 (21.9%) venous thromboembolism (VTE) patients had recurrent PE. Statistically significant risk factors for recurrence were inadequate treatment of index VTE (p 0.048) and previous DVT history (p 0.048). Bedridden, recent hospitalization, comorbidities and discharge with warfarin or LMWH and treatment duration were not statistically significantly different between two groups. Conclusion: Duration of anticoagulation should comply with guidelines. Prophylaxis with LMWH is mandatory for hospitalized patients with previous VTE history. Major bleeding risk is low and shouldn9t be a reason for inadequate treatment or prophylaxis.