Venous Thromboembolism In Elderly Patients Research Articles

A nomogram model based on the systemic immune-inflammation index to predict the risk of venous thromboembolism in elderly patients after hip fracture: A retrospective cohort study

Background and objectivesVenous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and secondary pulmonary embolism (PE), represents a significant complication post-hip fracture in the elderly. It is a prevalent cause of VTE-related complications, prolonged hospitalization, and mortality. This study aimed to investigate the potential of the systemic immune-inflammation index (SII) as a predictive marker for VTE in older patients following hip fracture. MethodsThe study was structured as an observational, analytical, retrospective cohort analysis. A total of 346 elderly patients diagnosed with hip fracture were included. We retrospectively collated clinical and laboratory data for these patients. Using the bootstrap method, the patients were divided in a 7:3 ratio into a training cohort (DVT group = 170 patients; no-DVT group = 72 patients) and an internal validation cohort (DVT group = 81 patients; no-DVT group = 23 patients). In the training cohort, relevant indices were initially identified using univariate analysis. Subsequently, least absolute shrinkage and selection operator logistic analysis was employed to determine significant potential independent risk factors (P < 0.05). A dynamic online diagnostic nomogram was developed, with its discriminative ability assessed using the area under the receiver operating characteristic curve (AUC). The nomogram's accuracy was further appraised using calibration plots. The clinical utility of the nomogram was evaluated through decision curve analysis (DCA) and corroborated by internal validation within the training set. ResultsSII emerged as the sole independent risk factor identified from the multivariate logistic analysis of the training cohort and was incorporated into the VTE diagnostic nomogram for older patients' post-hip fracture. The nomogram demonstrated AUC values of 0.648 in the training cohort and 0.545 in the internal testing cohort. Calibration curves corroborated the close alignment of the nomogram's predicted outcomes with the ideal curve, indicating consistency between predicted and actual outcomes. The DCA curve suggested that all patients could derive benefit from this model. These findings were also validated in the validation cohort. ConclusionThe systemic immune-inflammation index is a robust predictor of venous thromboembolism in elderly patients following hip fracture, underscoring its potential as a valuable tool in clinical practice.

PB0944 Association of Chemotherapy and Other Therapeutic Agents with Venous Thromboembolism in Elderly Patients with Acute Lymphocytic Leukemia in the United States

PB0944 Association of Chemotherapy and Other Therapeutic Agents with Venous Thromboembolism in Elderly Patients with Acute Lymphocytic Leukemia in the United States

Expert consensus on the prevention of venous thromboembolism for elderly patients with critical illness in China (2023)

Patients with critical illness are at the high risk of venous thromboembolism (VTE), and the older the patient, the higher the incidence of VTE. Despite its poor prognosis, VTE is preventable. At present, although there are many consensus or guidelines on the prevention of VTE at home and abroad, there is still a lack of consensus or guidelines for the prevention of VTE in elderly patients with critical illness. In order to standardize the prevention of VTE in elderly patients with critical illness in China, Expert consensus on the prevention of venous thromboembolism for elderly patients with critical illness in China (2023) was developed by Critical Care Medicine Division of Chinese Geriatric Society and Zhejiang Provincial Clinical Research Center for Critical Care Medicine. Members of the working group consulted relevant domestic and foreign guidelines, integrated evidence-based medical evidence and clinical experience, formed the draft consensus, submitted it to the expert group for discussion for many times, revised it for many times, and finally sent it to the expert group in the form of electronic questionnaire, and the expert gave a comprehensive score according to the theoretical basis, scientific nature and feasibility of the consensus items. The recommendation strength of each item was determined, and 21 recommendations were finally formed to provide reference for the prevention of VTE in elderly patients with critical illness.

Padua prediction score-guided use of low-molecular-weight heparin calcium treatment for the prevention of venous thromboembolism in elderly patients with intracerebral hemorrhage: a clinical observation

This study used the Padua Prediction Score (PPS) to guide low-molecular-weight heparin calcium (LMWHC) treatment for the prevention of venous thromboembolism (VTE) in elderly patients with intracerebral hemorrhage (ICH). This study retrospectively analyzed 225 elderly patients who were admitted to the intensive care unit (ICU) between June 2016 and June 2022. Patients were divided into control (n = 124) and study (n = 101) groups. Control patients received routine prevention and treatment of VTE, while patients in the study group received PPS-guided LMWHC treatment for the prevention of VTE. Multiple analytical parameters were assessed including thromboelastography indices, coagulation function parameters, venous blood flow velocity, and the incidence of VTE and recurrent ICH. Thromboelastography indices, coagulation function parameters, and the venous blood flow velocity did not differ significantly between the control and study groups (p &gt; 0.05) before intervention and treatment. However, following PPS-guided LMWHC treatment, a significant improvement in these parameters was observed in the study group compared to the control group (p &lt; 0.05). Furthermore, the incidence of VTE was significantly lower in the study group (5.6%) than the control group (14.5%; p = 0.038). No significance differences in the incidence of recurrent ICH were observed (p &gt; 0.05). Our PPS data indicate that LMWHC treatment could significantly improve the coagulation function of elderly patients with ICH, as well as increase the venous blood flow velocity and prevent the occurrence of VTE.

Venous-Thromboembolism in Elderly Patients with Diffuse Large B Cell Lymphoma

INTRODUCTION: Previous studies indicate that the risk of venous-thromboembolism (VTE) may be higher among patients with aggressive lymphoma. However, these studies were limited by small sample from single institutions and/or heterogeneous patient populations. There is a need to examine the risk of VTE in large population-based cohorts of patients within homogeneous sub-types of aggressive lymphoma, to provide evidence for recommendations for thromboprophylaxis. We used Surveillance, Epidemiology, and End Results registry data linked with Medicare, to examine the risk of VTE in elderly patients with diffuse large B cell lymphoma (DLBCL). METHODS: We identified 5,537 Medicare beneficiaries diagnosed with DLBCL at age ≥66 years between 2011 and 2015, with at least 1 year of coverage prior to diagnosis, and initiation of chemotherapy within 1 year post-diagnosis. We also identified a non-cancer cohort similar on age, sex, race/ethnicity (n=5,537). We ascertained pre-existing comorbidities for the 1 year prior to DLBCL diagnosis or pseudodiagnosis date (for the non-cancer cohort). Patients were followed from DLBCL diagnosis until development of new-onset VTE, or, in the absence of VTE diagnosis, for 5 years (if alive), or until death, loss of continuous Part A or Part B coverage, blood or marrow transplantation, or end of study (12/31/2016), whichever came first. VTE diagnosis was based on ICD 9 and ICD 10 codes for events including deep vein thrombosis (DVT) (ICD 9 codes: 4531, 4532, 45340, 45341, 45342, 4538, 4539 and ICD 10 codes: I82.4xx [I82.90, I82.49, I80.1, I80.2, I80.3, I80.8, I80.9]), and pulmonary embolism (PE) (ICD 9 codes: 41511, 41519 and ICD 10 codes: I26.0x and I26.9x). We used cumulative incidence function to assess the risk of post-DLBCL VTE. The risk of VTE in DLBCL patients was compared to Medicare beneficiaries without a history of cancer. In an analysis restricted to DLBCL patients, we used multivariable cox regression models to examine the following risk factors associated with VTE: age at DLBCL diagnosis, sex, race/ethnicity, socioeconomic status, and pre-existing comorbid conditions (hypertension, dyslipidemia, diabetes, obesity, chronic kidney disease, congestive heart failure, atrial fibrillation). We treated receipt of chemotherapy as a time varying covariate. RESULTS: Overall, 524 (9.5%) of the DLBCL patients and 80 (1.5%) of the controls were diagnosed with VTE. Adjusting for age, sex, race/ethnicity, education, and comorbid conditions, DLBCL patients were at a 6.7-fold higher risk of VTE compared to controls (95% confidence interval [CI]: 5.2-8.4, p&amp;lt;0.001) (Figure 1). In the analysis restricted to the 5,537 DLBCL patients, 61% had received cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab (RCHOP). Mean length of follow-up was 26.8 months (range: 0-71 months). The cumulative incidence of new-onset VTE was 7.3% at 6 months from diagnosis, 8.4% at 1 year, and 9.9% at 5 years (mean time to onset: 6.9 months from DLBCL, range: 0-52 months). Majority of the VTEs occurred within 6 months of DLBCL diagnosis. In the adjusted analysis, we did not identify any significant demographic, clinical or therapeutic factors associated with VTE. Of the 524 patients with VTE, 44 (8%) had a VTE-related hospitalization within 90 days of their first VTE, mean length of stay in the hospital was 14.8 days. Presenting with PE vs. DVT (relative risk [RR]=2.5, 95%CI: 1.2-5.3) was associated with a greater risk of hospitalization. Adjusting for the type of VTE, being obese (RR=8.7, 95%CI: 1.6-47.3) was also associated with a greater risk of hospitalization. CONCLUSION: In conclusion, elderly patients with DLBCL have substantially higher risk of VTE compared with a non-cancer comparison cohort. The majority of the events occur within the first 6 months of DLBCL diagnosis. Obesity is associated with a greater risk of VTE-related hospitalization. These findings identify a need for thromboprophylaxis for the first 6 months after DLBCL diagnosis. Disclosures Gangaraju: Sanofi Genzyme, Consultant for Cold Agglutinin Disease: Consultancy.

Risk of venous thromboembolism in elderly patients with vertebral compression fracture: A population-based case-control study.

Vertebral compression fractures (VCFs) are common in elderly and are treated with immobilization. Moreover, immobilization and old age may increase venous thromboembolism (VTE) risk. However, the incidence of VCFs-related VTE is unknown in elderly. The purposes of this study were to determine the incidence of VTE among VCF patients, to explore whether percutaneous vertebroplasty (PV) intervention may reduce VTE risk in VCFs patients.We conducted a population-based case-control study by using the National Health Insurance Research Database. We identified 1407 patients aged ≥65 with VCF who received PV and 1407 VCFs patients who did not receive PV after developing a 1:1 propensity score-matched study cohort and were followed up for 5 years. Using PV intervention as the exposure factor, a cause-specific Cox's proportional hazards model was used to examine the association between PV and VTE.After propensity score matching, the mean age of the study participants was 78 years and ∼23% of the analyzed participants were men, incidence of VTE in the PV and control cohorts was 5.77 and 4.19 per 1000 person-years, respectively. Both groups were nonsignificant difference after examination with different adjustment models. Patients with VCF and a history of heart failure, coronary artery disease, receiving antihypertension medication were at a significantly increased VTE risk.Elderly patients with VCF who received PV had a neutral impact on risk of VTE. VCF patients with heart failure, coronary artery disease, and receiving antihypertension medication were prone to developing VTE should be monitored cautiously.

Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants.

The incidence of venous thromboembolism (VTE) and VTE‑related morbidity and mortality increase with advancing age. Over the past decade, substantial advances in the treatment of VTE have been achieved. Most notably, direct oral anticoagulants (DOACs) were introduced, which offer simple treatment regimens across a broad spectrum of patients with VTE and have become the first‑choice anticoagulants in many individuals in this population. Even though elderly patients are underrepresented in clinical trials, the extrapolation of overall study results to the elderly subpopulation can be considered justified regarding acute VTE treatment and the choice of anticoagulant agent. In the elderly, DOACs are not only associated with a lower bleeding risk but they also appear to be even more efficacious than vitamin K antagonists in preventing recurrent VTE during the acute treatment period. Determining the optimal treatment duration is the most challenging aspect of VTE management in elderly patients. The risk of bleeding increases with advancing age, and several risk factors for recurrent VTE after stopping anticoagulation are also more frequent in the elderly. Clinical decision rules estimating the risk of recurrent VTE and bleeding have limited utility in elderly patients. Shared decision making considering patients' preferences and values is therefore crucial to help determine individual treatment duration in these patients.

Progress in research on venous thromboembolism in elderly patients with lung cancer

Venous thromboembolism(VTE)is one of the common and serious complications of malignant tumors.In elderly lung cancer patients, problems such as decreased autonomic activity, bed rest, poor performance status(PS), combined underlying diseases and the use of chemoradiotherapy are often considered as risk factors for high incidence of VTE.This article is aimed to review the clinical features and pathogenesis of lung cancer in the elderly combined with VTE, to investigate the risk factors and explore feasible evaluation and prevention strategies. Key words: Lung neoplasms; Venous thromboembolism; Risk factors

Venous-Thromboembolism in Elderly Patients with Acute Myeloid Leukemia

BACKGROUND: Venous-thromboembolism (VTE) is a debilitating condition and is associated with excess mortality. Small, single institution studies suggest that the risk of VTE in acute myeloid leukemia (AML) patients is elevated and is similar to that seen in solid tumor patients. However, population-based studies describing VTE risk and predictors of VTE in elderly AML patients are lacking. We used Medicare-linked SEER (Surveillance, Epidemiology, and End Results) data to address this knowledge gap. METHODS: We identified 4,166 Medicare beneficiaries diagnosed with AML at age ≥67y between 2007 and 2013. We ascertained baseline sociodemographics and pre-existing comorbidities for 2y prior to AML diagnosis. Patients were followed from AML diagnosis until development of post-AML VTE, or, in the absence of VTE diagnosis, for 2y (if alive), or until death, blood or marrow transplant, or end of study (12/31/2014), whichever came first. VTE diagnosis was based on ICD 9 codes using validated claims algorithms, and included deep vein thrombosis (DVT), pulmonary embolism (PE) and thrombophlebitis. Statistical Analysis: Cumulative incidence functions were used to assess post-AML VTE risk (overall, new-onset). Cox regression models examined the following risk factors associated with VTE: age at AML diagnosis, sex, race/ethnicity, socioeconomic status, history of pre-AML VTE, and pre-existing co-morbid conditions (hypertension, dyslipidemia, diabetes, stroke, rheumatoid arthritis, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, congestive heart failure, atrial fibrillation, anemia and peripheral vascular disease). RESULTS: Median age at AML diagnosis was 79y (range: 67-105y); 52% were male, 83% non-Hispanic white and 20% resided in an area where &gt;20% of the population lived below poverty level; 50% of the cohort received chemotherapy. Prior to AML diagnosis, 15% were receiving anticoagulants; 2% were on anticoagulation for pre-AML VTE. Cumulative Incidence of VTE: Overall, 167 (4.0%) patients were diagnosed with post-AML VTE (DVT [63%], PE [32%], thrombophlebitis [5%]); 38% had &gt;1 VTE. Of the 167 patients with post-AML VTE, only 25 (15%) had new-onset VTE; the remaining 142 carried a history of pre-AML VTE. The 2y cumulative incidence of any post-AML VTE was 4.3% (95%CI: 3.6%-5.1%) (Fig 1). Fifty-six percent of VTE episodes occurred within 3 months of AML diagnosis. The incidence was 0.6% (95% CI: 0.5%-0.8%) for new-onset VTE and was 1.9% (95%CI 1.3-2.6) for multiple VTEs. The 2y cumulative incidence of post-AML VTE among those with a history of pre-AML VTE was 17.1% (95% CI: 13.3-21.9%). Risk factors for VTE: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty, and co-morbid conditions, AML patients who had pre-AML VTE, were at 7.6-fold increased risk of post-AML VTE (95%CI: 4.8-12.0, p&lt;0.001). No other risk factors were associated with post-AML VTE risk, with the exception of a marginal association between a prior history of peripheral vascular disease and new-onset VTE (HR=3.5, 95%CI: 0.9-14.8, p=0.08) (Table 1). Risk factors for VTE among patients receiving chemotherapy: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty and co-morbid conditions, AML patients with pre-AML VTE were at 8.1-fold increased risk of any post-AML VTE (95%CI: 4.4-14.7, p&lt;0.001). Mortality associated with VTE: The 2y cumulative incidence of mortality for those with no pre-AML VTE was 91%, compared to 95% for those with a pre-AML VTE (HR 1.23, p=0.017). New-onset VTE after the diagnosis of AML was not associated with an increased risk in mortality (HR 1.04, p=0.705). CONCLUSION: History of VTE prior to diagnosis of AML significantly increases the risk of post-AML VTE and overall mortality. These findings can be used to inform appropriate thromboprophylaxis in elderly AML patients who carry a pre-AML diagnosis of VTE. Disclosures No relevant conflicts of interest to declare.

Association between the Level of Serum Vitamin B12 and Venous Thromboembolism in African American Population

Background Multiple risk factors have been linked to venous thromboembolism (VTE). It is well established that elevated level of homocysteine correlated with increased risk of VTE. Some studies showed that vitamin B12 deficiency may be the cause for homocysteinemia. Therefore, it is recommended by some groups that vitamin B12 should be supplemented in the patient with high homocysteine to prevent VTE. However, more recent study has shown that there is correlation between the high serum Vitamin B12 level and risk of VTE in cancer patients.[1] provoked VTE after orthopedic surgery was also shown to be associated with elevated vitamin B12 serum levels in elderly patients. The role of vitamin B12 in VTE patients is not fully understood. Our study is to see whether there is correlation between serum Vitamin B12 level and risk of VTE in general population. Methods 177 Patients admitted to Kingsbrook Jewish Medical Center between January 1st, 2015 to December 31st, 2018 with the diagnosis of VTE were identified. 95 cases had measured serum Vitamin B12 results within 3 months. 97 patients without any history of VTE who were seen in the hematology clinic during the same period time were used as control in this study. Demographic information and Vitamin B12 level were collected. T test and chi-square were used for statistical analysis. Results VTE patients had a median age of 70, which is significantly higher than the median age of 57 in the control group. The mean level of vitamin B12 in control group was 620 pg/mL, which was lower than the average vitamin B12 level (770 pg/mL, p=0.0344) in the VTE group. When we divided the patients into 3 groups based on Vitamin B12 level: Low B12 (&lt;250 pg/mL), Moderate B12 (250-800 pg/mL) and High B12 (&gt;800 pg/mL). We observed 41% of VTE patients have B12 level more than 800 pg/mL while only 20% of control patients have high B12 level (chi-square, p=0.006). Discussion Our study showed that vitamin B12 level is significantly elevated in patients diagnosed with VTE and more than 40% of those patients actually have vitamin b12 level more than 800 pg/mL. It is known that elevated vitamin B12 level is associated with inflammation and increased mortality.[2] An association between elevated B12 levels and cancer has been reported in several studies [3]. It is unclear elevated vitamin B12 levels predict undiagnosed cancer which is a known risk factor for VTE or vitamin B12 directly contribute hypercoagulation. Nevertheless, we should be cautious when supplementing vitamin B12 and the dosage may need to be titrated closely. More clinical studies are definitely warranted.

Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture

BackgroundLimited studies are available to investigate the prevalence of preoperative venous thromboembolism (VTE) in elderly patients with femoral neck fractures. Our primary aim was to determine the incidences of VTE and its risk or protective factors in such patient population. The secondary objective was to evaluate the need of therapeutic anticoagulation for isolated calf muscular venous thrombosis (ICMVT) prior to femoral neck fracture surgery.MethodsThis is a retrospective case-control study, including 301 femoral neck fracture patients who were admitted to our institution between January 2014 and March 2017. Bilateral Doppler ultrasonography was performed in each of the patients as a preoperative VTE screening. The event rate of VTE was calculated, and significant risk or protective factors were determined by using a multivariate logistic regression model. Patients with ICMVT were divided into anticoagulation and no anticoagulation groups to assess the efficacy and safety of preoperative therapeutic anticoagulation. Intraoperative blood loss, drainage volume, blood transfusion, perioperative hemoglobin change, and rate of thrombosis extension were compared between the two groups.ResultsThe overall preoperative incidence of VTE in patients with femoral neck fracture was 18.9% (57/301), in which deep vein thrombosis (DVT) was 18.9% and pulmonary embolism (PE) was 1%. Among the DVT cases, 77.2% (44/57) were ICMVTs. Multiple fractures (odds ratio [OR] = 9.418; 95% confidence interval [CI] = 2.537 to 34.96), coexisting movement disorder (OR = 3.862; 95% CI = 1.658 to 8.993), bed rest for more than 7 days (OR = 2.082; 95% CI = 1.011 to 4.284) as well as elevated levels of D-dimer (OR = 1.019; 95% CI = 1.002 to 1.037) and fibrinogen (OR = 1.345; 95% CI = 1.008 to 1.796) led to an increase in the risk of VTE, while the recent use of antiplatelet drug (OR = 0.424; 95% CI = 0.181 to 0.995) and prophylactic anticoagulation (OR = 0.503; 95% CI = 0.263 to 0.959) decreased the risk of VTE. For the 39 patients with ICMVT undergoing femoral neck fracture surgery, there were no significant differences in the rate of thrombosis extension between anticoagulation and no anticoagulation groups, but significantly decreased postoperative hemoglobin was observed in the anticoagulation group.ConclusionOur findings showed a high prevalence of preoperative VTE in elderly patients with femoral neck fracture, with risk factors identified. We found that the most detected VTE were ICMVTs. Our study suggested that a direct surgery without preoperative use of therapeutic anticoagulation for ICMVT would not reduce the risk of thrombus extension, and the therapeutic use of anticoagulation may worsen postoperative anemia.

AGE-RELATED DIFFERENCES IN THE EFFICACY OF DIRECT ORAL ANTICOAGULANT USE FOR VTE PREVENTION IN ELDERLY VS NONELDERLY PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

SESSION TITLE: Pulmonary Vascular Disease 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: To address the relationship between age and the efficacy and safety of the direct oral anticoagulants (DOACs), we performed a systematic review and meta-analysis to evaluate the incidence of recurrent venous thromboembolism (VTE) in non-elderly (less than or equal to 65 years) versus elderly patients (greater than 65 years) with acute VTE treated with DOACs compared to vitamin K antagonists (VKAs). Previous meta-analyses evaluated this using age cutoffs of greater than or less than 75 years, with the former group making up a small portion of the study population in the respective DOAC trials. METHODS: We searched several databases from inception until 1 November 2017 for comparative studies evaluating the use of DOACs in preventing recurrent VTE in elderly versus non-elderly patients.. Search terms included 'novel oral anticoagulant', 'vitamin K antagonist', 'warfarin', and/or venous thromboembolism. The outcome of interest was recurrent VTE. Pooled risk ratios (RR) were pooled and analyzed using a random effects model. RESULTS: Eight studies including 26,350 patients were included in this analysis. For incidence of recurrent VTE in the study population, pooled RR was 0.87 (0.60 - 1.24). For recurrent VTE in non-elderly patients, pooled RR was 0.52 (0.27 - 0.99). Significant heterogeneity of 91% was noted for this outcome. For recurrent VTE in elderly patients, pooled RR was 0.56 (0.33 - 0.94). Significant heterogeneity of 71% was noted for this outcome. The heterogeneity persisted for recurrent VTE in both elderly and non-elderly patients despite adjusting for specific DOAC used. CONCLUSIONS: Moderate-to-high quality evidence suggests DOAC use was associated with a statistically significant reduction in the incidence of recurrent VTE in elderly and non-elderly patients. Significant heterogeneity noted for the outcome of interest indicates the reduction in VTE could be due to chance. CLINICAL IMPLICATIONS: Further randomized trials with elderly and non-elderly patients are needed to determine if DOAC use in patients with VTE is truly non-inferior to warfarin in this important subgroup of patients. DISCLOSURES: No relevant relationships by Christopher Jackson, source=Web Response No relevant relationships by Ankur Seth, source=Web Response

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Background The study compares different D-dimer assays and age-adjusted cut-offs in outpatients with suspected venous thromboembolism (VTE). The plasma concentration of this sensitive biomarker is increased by activated coagulation, but also by several conditions that are linked to an increased risk of VTE. One such condition is old age, which poses a common clinical problem where many prefer not to analyze D-dimer in elderly patients. Age-adjusted cut-offs have been validated for both deep venous thrombosis (DVT) and pulmonary embolism, aiming to increase specificity without notably decreasing sensitivity. Objectives We evaluated four common D-dimer assays in parallel, with and without applying age-adjusted cut offs for VTE. Patients/methods The prospective single-center study was conducted in 940 outpatients attending the emergency department with clinically suspected pulmonary embolism or DVT. Four automated D-dimer assays were compared (Siemens INNOVANCE® , Roche Tina-quant, Medirox MRX and STA® -Liatest® D-Di PLUS). Results All assays performed with areas under the ROC curve (AUC) > 0.9 and maintained their sensitivities after implementation of age-adjusted cut-offs. Specificities increased by 6-7% and number needed to test decreased by < 0.3. The rate of false positive results decreased by 6% overall and by 10-20% for patients ≥ 70. Conclusions Age-adjusted cut-offs resulted in maintained high sensitivity and a modest improvement in specificity and number needed to test for all evaluated D-dimer assays. There was a significant reduction in false positive results, which reflects avoidable unnecessary imaging without any compromise of clinical safety. This suggests a potential to benefit the management of VTE in elderly patients, both clinically and economically.

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

BackgroundLittle is known about predictors and outcomes of recurrent venous thromboembolism in elderly patients. MethodsWe prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was symptomatic recurrent venous thromboembolism. We explored the association between baseline characteristics and treatments and recurrent venous thromboembolism using competing risk regression, adjusting for periods of anticoagulation as a time-varying covariate. We also assessed the clinical consequences (case-fatality, localization) of recurrent venous thromboembolism. ResultsDuring a median follow-up period of 30 months, 122 patients developed recurrent venous thromboembolism, corresponding to a 3-year cumulative incidence of 14.8%. The case-fatality of recurrence was high (20.5%), particularly in patients with unprovoked (23%) and cancer-related venous thromboembolism (29%). After adjustment, only unprovoked venous thromboembolism (sub-hazard ratio, 1.67 compared with provoked venous thromboembolism; 95% confidence interval, 1.00-2.77) and proximal deep vein thrombosis (sub-hazard ratio, 2.41 compared with isolated distal deep vein thrombosis; 95% confidence interval, 1.07-5.38) were significantly associated with recurrence. Patients with initial pulmonary embolism were more likely to have another pulmonary embolism as a recurrent event than patients with deep vein thrombosis. ConclusionsElderly patients with acute venous thromboembolism have a substantial long-term risk of recurrent venous thromboembolism, and recurrence carries a high case-fatality rate. Only 2 factors, unprovoked venous thromboembolism and proximal deep vein thrombosis, were independently associated with recurrent venous thromboembolism, indicating that traditional risk factors for venous thromboembolism recurrence (eg, cancer) may be less relevant in the elderly.

Does preoperative mechanical prophylaxis have additional effectiveness in preventing postoperative venous thromboembolism in elderly patients with hip fracture?-Retrospective case-control study.

BackgroundElderly patients undergoing hip fracture surgery (HFS) are at increased risk of postoperative venous thromboembolism (VTE). To reduce this risk, combined postoperative mechanical and chemical thromboprophylaxis has been routinely performed after HFS in these patients. This retrospective case-control study was conducted to evaluate the additional effectiveness of preoperative mechanical thromboprophylaxis for the prevention of VTE following HFS in elderly patients.MethodsOf 539 consecutive patients aged 70 years or older undergoing HFS, 404 (control group) did not receive preoperative mechanical thromboprophylaxis, while 135 (study group) received mechanical thromboprophylaxis using an intermittent pneumatic compression device and graduated compression stockings from the time of admission until surgery. All patients received combined postoperative mechanical and chemical thromboprophylaxis following HFS in accordance with the same protocol. The incidence of symptomatic VTE confirmed based on clinical symptoms and 3-dimensional CT angiography within one month of surgery was investigated in both groups.ResultsThe American Society of Anesthesiologists grade was higher (p = 0.016) in the study group and more patients in this group had concomitant cardiovascular and neurologic diseases (p = 0.005 and p = 0.009, respectively). In addition, more patients in the study group had received anticoagulant medication preinjury owing to comorbidities (39% vs 28%, p = 0.025). The overall incidences of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) were 7.4% and 3.7%, and 2.2% and 1.5% in the control and study groups, respectively. According to multiple logistic regression, symptomatic DVT significantly reduced in the study group (OR 0.28, p = 0.042), while there was no significant difference in the incidence of symptomatic PE between the two groups (p = 0.223).ConclusionsPreoperative mechanical thromboprophylaxis may confer an additional benefit by preventing postoperative VTE without adding more risk of perioperative bleeding in elderly patients with hip fracture.

P5320Trimethylamine-N-oxide (TMAO) Predicts Total Mortality, but not Recurrent Venous Thromboembolism in Elderly Patients with Acute Venous Thromboembolism

P5320Trimethylamine-N-oxide (TMAO) Predicts Total Mortality, but not Recurrent Venous Thromboembolism in Elderly Patients with Acute Venous Thromboembolism

Do Factor V Leiden and Prothrombin G20210A Mutations Predict Recurrent Venous Thromboembolism in Older Patients?

BackgroundThe value of genetic thrombophilia testing in elderly patients with an unprovoked venous thromboembolism is unclear. We assessed whether the Factor V Leiden and the prothrombin G20210A mutation are associated with recurrent venous thromboembolism in elderly patients in a prospective multicenter cohort study. MethodsWe genotyped the Factor V Leiden and the prothrombin G20210A mutation in 354 consecutive in- and outpatients aged ≥65 years with a first unprovoked venous thromboembolism from 9 Swiss hospitals. Patients and managing physicians were blinded to testing results. The outcome was recurrent symptomatic venous thromboembolism during follow-up. We examined the association between the Factor V Leiden and the prothrombin G20210A mutation and venous thromboembolism recurrence using competing risk regression, adjusting for age, sex, and periods of anticoagulation as a time-varying covariate. ResultsOverall, 9.0% of patients had a Factor V Leiden and 3.7% had a prothrombin G20210A mutation. At 36 months of follow-up, patients with a Factor V Leiden and a prothrombin G20210A mutation had a cumulative incidence of recurrent venous thromboembolism of 12.9% (95% confidence interval [CI], 5.1%-30.8%) and 18.5% (95% CI, 4.9%-56.5%), respectively, compared with 16.7% (95% CI, 12.5%-22.1%) of patients without mutation (P = .91 by the log-rank test). After adjustment, neither the Factor V Leiden (sub-hazard ratio 0.98; 95% CI, 0.35-2.77) nor the prothrombin G20210A mutation (sub-hazard ratio 1.15; 95% CI, 0.25-5.19) was associated with recurrent venous thromboembolism. ConclusionOur results suggest that testing for genetic thrombophilia may not be beneficial in elderly patients with a first unprovoked venous thromboembolism.

Analysis on risk factors for venous thromboembolism in elderly patients with lung cancer

Objective To investigate the risk factors for venous thromboembolism in elderly patients with lung cancer, in order to provide theoretical basis for clinical prevention and treatment. Methods A retrospective analysis was carried out in 869 elderly patients who were treated in our hospital from Mar. 2010 to Mar. 2014. And the venous thromboembolism and its related risk factors in elderly lung cancer patients were analyzed. Results 35 cases (4.35%) complicated with venous thromboembolism. Multivariate logistic regression analysis showed that adenocarcinoma, basic diseases, and D-dipolymer≥300 μg/L belonged to the independent risk factors for the complication of venous thromboembolism in elderly patients with lung cancer (OR=2.839, 1.586 and 10.514, respectively, P=0.007, 0.022 and 0.000). Conclusions The risk factors for the complication of venous thromboembolism should be monitored in the treatment of elderly patients with lung cancer. Early anticoagulation therapy should be performed to improve clinical effect and reduce the incidence of complications. Key words: Lung neoplasms; Venous thromboembolism; Risk factors

Antipsychotic Drug Use and the Risk of Venous Thromboembolism in Elderly Patients With Dementia

The aim of this study was to investigate the association between the use of antipsychotics and the risk of venous thromboembolism (VTE) in elderly patients with dementia. Based on data from the German Pharmacoepidemiological Research Database, a nested case-control study was conducted within a cohort of 72,591 patients with dementia aged at least 65 years at cohort entry. Cases were patients with a hospitalization due to VTE. Up to 4 controls were matched to each case according to age, sex, health insurance, and calendar time of the VTE. Users of antipsychotics were classified into current or former users, and in addition, all current users were categorized as prevalent or new users. For a further analysis, we distinguished between users of either conventional or atypical antipsychotics or concurrent users of both conventional and atypical antipsychotics. Multivariate conditional logistic regression was applied to calculate odds ratios (ORs) of VTE for all user groups compared with nonusers. The case-control data set comprised 1028 VTE cases and 4109 controls. An increased risk of VTE was found for current users (OR, 1.23; 95% confidence interval [CI], 1.01-1.50) and for users of a combination of atypical and conventional antipsychotics (OR, 1.62; 95% CI, 1.15-2.27). In current users, only new use was associated with an increased risk (OR, 1.63; 95% CI, 1.10-2.40). Increased attention to clinical signs of VTE should be paid during the first 3 months of treatment with antipsychotics and in patients receiving both conventional and atypical agents, especially if other risk factors for VTE exist.

Increased Risk of Chemotherapy-Associated Venous Thromboembolism in Elderly Patients with Cancer

Data on the relationship between aging, chemotherapy, and risk for venous thromboembolism (VTE) are controversial. We sought to evaluate the risk of chemotherapy-associated VTE in young to middle-aged (YMA) and elderly cancer patients and to analyze the VTE-free survival time in both groups. Patients with histologically confirmed diagnosis of solid malignancy receiving any type of systemic chemotherapy, no clinical diagnosis of VTE before chemotherapy initiation, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤2 were enrolled in this study. Of the 486 consecutive patients included in the study, 380 (78%) were classified as YMA (≤70 years of age) and 106 (22%) as elderly (>70 years of age). At a median follow-up of 1 year, the incidence of VTE events was almost two-fold greater in elderly than in YMA (11% vs. 6%). Age (≤70 years vs. >70 years (hazard ratio [HR], 2.42; 95% confidence interval [CI] 1.15-5.06; p=0.020), ECOG-PS (HR, 6.54; 95% CI 3.10-13.8; p<0.0001), and platinum-based chemotherapy (HR, 2.46; 95% CI 1.06-5.69; p=0.035) were independent risk factors for VTE. In the elderly subset, a trend toward an increased risk of VTE in patients receiving a platinum-based chemotherapy when compared with a non-platinum-containing regimen was observed (15% vs. 9.1%). The Kaplan-Meier analysis showed that elderly patients had a significantly shorter VTE-free survival time compared with younger cancer patients (log-rank test=2.0; p=0.045). Our study reports an increase incidence of VTE in elderly cancer patients treated with chemotherapy compared with the younger group, suggesting that aging is one of the most important risk factors for VTE. On the basis of the results of this study, we believe that a validated predictive model including age, ECOG-PS, and type of chemotherapy (platinum- vs. non-platinum containing regimen) would enable clinicians to target thromboprophylaxis to those patients considered to be at greatest risk.