Navigation auf zora.uzh.ch

Search ZORA

ZORA (Zurich Open Repository and Archive)

Anticoagulation management practices and outcomes in elderly patients with acute venous thromboembolism: A clinical research study

Insam, Charlène; Méan, Marie; Limacher, Andreas; Angelillo-Scherrer, Anne; Aschwanden, Markus; Banyai, Martin; Beer, Juerg-Hans; Bounameaux, Henri; Egloff, Michael; Frauchiger, Beat; Husmann, Marc; Kucher, Nils; Lämmle, Bernhard; Matter, Christian; Osterwalder, Joseph; Righini, Marc; Staub, Daniel; Rodondi, Nicolas; Aujesky, Drahomir (2016). Anticoagulation management practices and outcomes in elderly patients with acute venous thromboembolism: A clinical research study. PLoS ONE, 11(2):e0148348.

Abstract

Whether anticoagulation management practices are associated with improved outcomes in elderly patients with acute venous thromboembolism (VTE) is uncertain. Thus, we aimed to examine whether practices recommended by the American College of Chest Physicians guidelines are associated with outcomes in elderly patients with VTE. We studied 991 patients aged ≥65 years with acute VTE in a Swiss prospective multicenter cohort study and assessed the adherence to four management practices: parenteral anticoagulation ≥5 days, INR ≥2.0 for ≥24 hours before stopping parenteral anticoagulation, early start with vitamin K antagonists (VKA) ≤24 hours of VTE diagnosis, and the use of low-molecular-weight heparin (LMWH) or fondaparinux. The outcomes were all-cause mortality, VTE recurrence, and major bleeding at 6 months, and the length of hospital stay (LOS). We used Cox regression and lognormal survival models, adjusting for patient characteristics. Overall, 9% of patients died, 3% had VTE recurrence, and 7% major bleeding. Early start with VKA was associated with a lower risk of major bleeding (adjusted hazard ratio 0.37, 95% CI 0.20-0.71). Early start with VKA (adjusted time ratio [TR] 0.77, 95% CI 0.69-0.86) and use of LMWH/fondaparinux (adjusted TR 0.87, 95% CI 0.78-0.97) were associated with a shorter LOS. An INR ≥2.0 for ≥24 hours before stopping parenteral anticoagulants was associated with a longer LOS (adjusted TR 1.2, 95% CI 1.08-1.33). In elderly patients with VTE, the adherence to recommended anticoagulation management practices showed mixed results. In conclusion, only early start with VKA and use of parenteral LMWH/fondaparinux were associated with better outcomes.

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Angiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Life Sciences > General Biochemistry, Genetics and Molecular Biology
Life Sciences > General Agricultural and Biological Sciences
Health Sciences > Multidisciplinary
Language:English
Date:2016
Deposited On:21 Mar 2016 16:41
Last Modified:15 Oct 2024 01:38
Publisher:Public Library of Science (PLoS)
ISSN:1932-6203
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1371/journal.pone.0148348
PubMed ID:26906217
Download PDF  'Anticoagulation management practices and outcomes in elderly patients with acute venous thromboembolism: A clinical research study'.
Preview
  • Content: Published Version
  • Language: English
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)

Metadata Export

Statistics

Citations

Dimensions.ai Metrics
8 citations in Web of Science®
10 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

60 downloads since deposited on 21 Mar 2016
2 downloads since 12 months
Detailed statistics

Authors, Affiliations, Collaborations

Similar Publications