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Prevention and treatment of venous thromboembolism in older people

Published online by Cambridge University Press:  01 August 2008

A Veiraiah*
Affiliation:
Cardiff and Vale NHS Trust, Cardiff, Wales, UK
HGM Shetty
Affiliation:
Cardiff and Vale NHS Trust, Cardiff, Wales, UK
PA Routledge
Affiliation:
Cardiff University, Wales, UK
*
Address for correspondence: Arvindan Veiraiah, Department of Clinical Pharmacology, Academic Centre, University Hospital Llandough, Penarth CF64 2XX, Wales, UK. Email: drveiraiah@doctors.org.uk

Extract

The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively called venous thromboembolism (VTE), increases with age and has been reported to be higher in males. The annual incidence rates per 1000 for DVT and PE are 1.3 and 1.8, respectively, for people aged between 65 and 69 years, rising to 2.8 and 3.1, respectively, in those aged between 85 and 89 years. Older people are about eight times more likely to develop VTE in hospitals, nursing homes or other chronic care facilities than younger adults. About 1.7% develop PE within one year of treatment for DVT, whilst the one year recurrence rate for PE was 8.0%. About 3% of patients with DVT and 21% of those with PE die in hospital. One year mortality with DVT is 21% and that with PE is 39%.

Type
Clinical geriatrics
Copyright
Copyright © Cambridge University Press 2009

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References

1Kniffin, WD Jr, Baron, JA, Barrett, J, Birkmeyer, JD, Anderson, FA Jr. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994; 154: 861–6.CrossRefGoogle ScholarPubMed
2Chang, KP, Center, JR, Nguyen, TV, Eisman, JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 2004; 19: 532–6.CrossRefGoogle ScholarPubMed
3Girasole, GJ, Cuomo, F, Denton, JR, O'Connor, D, Ernst, A. Diagnosis of deep vein thrombosis in elderly hip-fracture patients by using the duplex scanning technique. Orthop Rev 1994; 23: 411–6.Google ScholarPubMed
4Lawall, H, Hoffmanns, W, Hoffmanns, P et al. Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission. Thromb Haemost 2007; 98: 765–70.Google ScholarPubMed
5Sandler, DA, Martin, JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82: 203–5.CrossRefGoogle ScholarPubMed
6Cohen, AT, Agnelli, G, Anderson, FA et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756–64.Google ScholarPubMed
7Alikhan, R, Peters, F, Wilmott, R, Cohen, AT. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol 2004; 57: 1254–7.CrossRefGoogle ScholarPubMed
8Heit, JA, Silverstein, MD, Mohr, DN, Petterson, TM, O'Fallon, WM, Melton, LJ 3rd. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med 1999; 159: 445–53.CrossRefGoogle ScholarPubMed
9House of Commons Health Committee report. The prevention of venous thromboembolism in hospitalised patients, 2005. Accessed on 23/03/08 from http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/99/99.pdfGoogle Scholar
10Fratantoni, J, Wessler, S. Prophylactic therapy of deep vein thrombosis and pulmonary embolism. DHEW: (NIH) 76–866, Washington, DC: US Government Printing Office, 1975.Google Scholar
11Steier, KJ, Singh, G, Ullah, A, Maneja, J, Ha, RS, Khan, F. Venous thromboembolism: application and effectiveness of the American College of Chest Physicians 2001 guidelines for prophylaxis. J Am Osteopath Assoc 2006; 106: 388–95.Google ScholarPubMed
12South, A, Iveson, E, Allgar, V, Harbison, J. Geriatrics Registrars Research and Audit Network Yorkshire. The under use of thromboprophylaxis in older medical in-patients: a regional audit. QJM 2007; 100: 685–9.CrossRefGoogle ScholarPubMed
13Cohen, AT, Tapson, VF, Bergmann, JF et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371 (9610): 387–94.CrossRefGoogle ScholarPubMed
14NICE Clinical Guidance. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery. Accessed on 17/1/08 from www.nice.org.uk/nicemedia/pdf/VTEFullGuide.pdfGoogle Scholar
15Samama, MM, Cohen, AT, Darmon, JY et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 1999; 341: 793800.CrossRefGoogle ScholarPubMed
16Desjardins, L, Bara, L, Boutitie, F et al. Correlation of plasma coagulation parameters with thromboprophylaxis, patient characteristics, and outcome in the MEDENOX study. Arch Pathol Lab Med 2004; 128: 519–26.CrossRefGoogle ScholarPubMed
17Berges, A, Laporte, S, Epinat, M et al. Anti-factor Xa activity of enoxaparin administered at prophylactic dosage to patients over 75 years old. Br J Clin Pharmacol 2007; 64: 428–38.CrossRefGoogle ScholarPubMed
18Lamy, A, Wang, X, Kent, R, Smith, KM, Gafni, A. Economic evaluation of the MEDENOX trial: a Canadian perspective. Medical Patients with Enoxaparin. Can Respir J 2002; 9: 169–77.CrossRefGoogle Scholar
19Kucher, N, Leizorovicz, A, Vaitkus, PT et al. Efficacy and safety of fixed low-dose dalteparin in preventing venous thromboembolism among obese or elderly hospitalized patients: a subgroup analysis of the PREVENT trial. Arch Intern Med 2005; 165: 341–5.CrossRefGoogle ScholarPubMed
20Cohen, AT, Davidson, BL, Gallus, AS et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 2006; 332 (7537): 325–9.CrossRefGoogle ScholarPubMed
21Richards, GA, Schoeman, HS. Prophylaxis of venous thrombosis in medical patients: A real-world perspective. Cardiovasc J S Afr 2006; 17: 251–4.Google ScholarPubMed
22Kucher, N, Koo, S, Quiroz, R et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352: 969–77.CrossRefGoogle ScholarPubMed
23Ageno, W, Turpie, AG. Clinical trials of deep vein thrombosis prophylaxis in medical patients. Clin Cornerstone 2005; 7: 1622.CrossRefGoogle ScholarPubMed
24Själander, A, Jansson, JH, Bergqvist, D, Eriksson, H, Carlberg, B, Svensson, P. Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis. J Intern Med 2008; 263: 5260.CrossRefGoogle ScholarPubMed
25Wein, L, Wein, S, Haas, SJ, Shaw, J, Krum, H. Pharmacological venous thromboembolism prophylaxis in hospitalized medical patients: a meta-analysis of randomized controlled trials. Arch Intern Med 2007; 167: 1476–86.CrossRefGoogle ScholarPubMed
26Kanaan, AO, Silva, MA, Donovan, JL, Roy, T, Al-Homsi, AS. Meta-analysis of venous thromboembolism prophylaxis in medically Ill patients. Clin Ther 2007; 29: 2395–405.CrossRefGoogle ScholarPubMed
27Dentali, F, Douketis, JD, Gianni, M, Lim, W, Crowther, MA. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 2007; 146: 278–88.CrossRefGoogle ScholarPubMed
28Hollander, M, Koudstaal, PJ, Bots, ML, Grobbee, DE, Hofman, A, Breteler, MM. Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study. J Neurol Neurosurg Psychiat 2003; 74: 317–21.CrossRefGoogle ScholarPubMed
29André, C, de Freitas, GR, Fukujima, MM. Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic review of published articles. Eur J Neurol 2007; 14: 2132.CrossRefGoogle ScholarPubMed
30Kelly, J, Rudd, T, Lewis, RR, Hunt, BJ. Mortality from pulmonary embolism after acute stroke: can we do better? Age Ageing 2002; 31: 159–61.CrossRefGoogle ScholarPubMed
31Gorter, JW. Major bleeding during anticoagulation after cerebral ischemia: patterns and risk factors. Stroke Prevention In Reversible Ischemia Trial (SPIRIT). European Atrial Fibrillation Trial (EAFT) study groups. Neurology 1999; 53: 1319–27.CrossRefGoogle ScholarPubMed
32Mazzone, C, Chiodo, GF, Sandercock, P, Miccio, M, Salvi, R. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev 2004 Oct 18; (4): CD001922.CrossRefGoogle Scholar
33Albers, GW, Amarenco, P, Easton, JD, Sacco, RL, Teal, P. Antithrombotic and thrombolytic therapy for ischemic stroke: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (3 suppl): 483512S.CrossRefGoogle ScholarPubMed
34Stein, PD, Beemath, A, Meyers, FA, Olson, RE. Pulmonary embolism and deep venous thrombosis in hospitalized adults with chronic obstructive pulmonary disease. J Cardiovasc Med (Hagerstown) 2007; 8: 253–7.CrossRefGoogle ScholarPubMed
35Schönhofer, B, Köhler, D. Relevance of deep venous thrombosis of the leg in patients with acute exacerbated COPD. Pneumologie 1999; 53: 1014.Google ScholarPubMed
36Shetty, R, Seddighzadeh, A, Piazza, G, Goldhaber, SZ. Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination. J Thromb Thrombolysis 2008; 26: 3540.CrossRefGoogle ScholarPubMed
37Siddique, RM, Siddique, MI, Connors, AF Jr, Rimm, AA. Thirty-day case-fatality rates for pulmonary embolism in the elderly. Arch Intern Med 1996; 156: 2343–7.CrossRefGoogle ScholarPubMed
38López-Jiménez, L, Montero, M, González-Fajardo, JA et al. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica 2006; 91: 1046–51.Google ScholarPubMed
39Masotti, L, Ceccarelli, E, Forconi, S, Cappelli, R. [Diagnostic and therapeutic features of pulmonary embolism in elderly patients] Ital Heart J Suppl 2003; 4: 745–54.Google ScholarPubMed
40Sohne, M, Kruip, MJ, Nijkeuter, M et al. Accuracy of clinical decision rule, D-dimer and spiral computed tomography in patients with malignancy, previous venous thromboembolism, COPD or heart failure and in older patients with suspected pulmonary embolism. J Thromb Haemost 2006; 4: 1042–6.CrossRefGoogle ScholarPubMed
41Antonelli, F, Villani, L, Masotti, L, Landini, G. Ruling out the diagnosis of venous thromboembolism in the elderly: is it time to revise the role of D-dimer? Am J Emerg Med 2007; 25: 727–8.CrossRefGoogle ScholarPubMed
42Modesto-Alapont, M, Nauffal-Manzur, D, Ansótegui-Barrera, E et al. Can home prophylaxis for venous thromboembolism reduce mortality rates in patients with chronic obstructive pulmonary disease? Arch Bronconeumol 2006; 42: 130–4.CrossRefGoogle ScholarPubMed
43Sellier, E, Labarere, J, Bosson, JL et al. Effectiveness of a guideline for venous thromboembolism prophylaxis in elderly post-acute care patients: a multicenter study with systematic ultrasonographic examination. Arch Intern Med 2006; 166: 2065–71.CrossRefGoogle ScholarPubMed
44Freedman, KB, Brookenthal, KR, Fitzgerald, RH Jr, Williams, S, Lonner, JH. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am 2000; 82-A: 929–38.CrossRefGoogle ScholarPubMed
45Hull, RD, Raskob, GE, Pineo, GF et al. Subcutaneous low-molecular-weight heparin vs warfarin for prophylaxis of deep vein thrombosis after hip or knee implantation. An economic perspective. Arch Intern Med 1997; 157: 298303.CrossRefGoogle ScholarPubMed
46Young, T, Tang, H, Aukes, J, Hughes, R. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev 2007; (3): CD006212. Review. Update in: Cochrane Database Syst Rev 2007; (4): CD006212.CrossRefGoogle Scholar
47Baglin, TP, Keeling, DM, Watson, HGand the British Committee for Standards in Haematology. Guidelines on oral anticoagulation (warfarin): 3rd edition, 2005 update. Br J Haematol 2006; 132, 277285.CrossRefGoogle Scholar
48Guidelines on oral anticoagulation: 3rd edition. Br J Haematol 1998; 101: 374–87.CrossRefGoogle Scholar
49Campbell, IA, Bentley, DP, Prescott, RJ, Routledge, PA, Shetty, HG, Williamson, IJ. Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. BMJ 2007; 334 (7595): 674.CrossRefGoogle ScholarPubMed
50BTS Guidelines for the Management of Suspected Acute Pulmonary Embolism, 2003. The British Thoracic Society Standards of Care Committee, Pulmonary Embolism Guideline Development Group. Thorax 2003; 48: 470–84.Google Scholar
51Eikelboom, JW, Ginsberg, JS, Hirsh, J. Anticoagulation for venous thromboembolism. BMJ 2007; 334 (7595): 645.CrossRefGoogle ScholarPubMed
52Othieno, R, Abu Affan, M, Okpo, E. Home versus in-patient treatment for deep vein thrombosis. Cochrane Database Syst Rev 2007; (3): CD003076.CrossRefGoogle Scholar
53Van Der Heijden, JF, Hutten, BA, Buller, HR, Prins, MH. Vitamin K antagonists or low-molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism. Cochrane Database Syst Rev 2002; (1): CD002001.CrossRefGoogle Scholar
54Winter, M, Keeling, D, Sharpen, F, Cohen, H, Vallance, P; Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology. Procedures for the outpatient management of patients with deep venous thrombosis. Clin Lab Haematol 2005; 27: 61–6.CrossRefGoogle ScholarPubMed
55Almahameed, A, Carman, TL. Outpatient management of stable acute pulmonary embolism: proposed accelerated pathway for risk stratification. Am J Med 2007; 120 (10 suppl. 2): S1825.CrossRefGoogle ScholarPubMed
56Fennerty, A, Dolben, J, Thomas, P et al. Flexible induction dose regimen for warfarin and prediction of maintenance dose. Br Med J (Clin Res Ed) 1984; 288 (6426): 1268–70.CrossRefGoogle ScholarPubMed
57Cosh, DG, Moritz, CK, Ashman, KJ, Dally, RJ, Gallus, AS. Prospective evaluation of a flexible protocol for starting treatment with warfarin and predicting its maintenance dose. Aust N Z J Med 1989; 19: 191–7.CrossRefGoogle ScholarPubMed
58Siguret, V, Gouin, I, Debray, M et al. Initiation of warfarin therapy in elderly medical inpatients: a safe and accurate regimen. Am J Med 2005; 118: 137–42.CrossRefGoogle ScholarPubMed
59van Leeuwen, Y, Rombouts, EK, Kruithof, CJ, Van Der Meer, FJ, Rosendaal, FR. Improved control of oral anticoagulant dosing: a randomized controlled trial comparing two computer algorithms. J Thromb Haemost 2007; 5: 1644–9.CrossRefGoogle ScholarPubMed
60Palareti, G, Leali, N, Coccheri, S et al. Hemorrhagic complications of oral anticoagulant therapy: results of a prospective multicenter study ISCOAT (Italian Study on Complications of Oral Anticoagulant Therapy) G Ital Cardiol 1997; 27: 231–43.Google Scholar
61Berwaerts, J, Webster, J. Analysis of risk factors involved in oral-anticoagulant-related intracranial haemorrhages. QJM 2000; 93: 513–21.CrossRefGoogle ScholarPubMed
62Cantalapiedra, A, Gutierrez, O, Tortosa, JI et al. Oral anticoagulant treatment: risk factors involved in 500 intracranial hemorrhages. J Thromb Thrombolysis 2006; 22: 113–20.CrossRefGoogle ScholarPubMed
63Fiore, LD, Scola, MA, Cantillon, CE, Brophy, MT. Anaphylactoid reactions to vitamin K. J Thromb Thrombolysis 2001; 11: 175–83.CrossRefGoogle ScholarPubMed
64Pereira, SP, Williams, R. Adverse events associated with vitamin K1: results of a worldwide postmarketing surveillance programme. Pharmacoepidemiol Drug Saf 1998; 7: 173–82.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
65Hylek, EM, Regan, S, Go, AS, Hughes, RA, Singer, DE, Skates, SJ. Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med 2001; 135: 393400.CrossRefGoogle ScholarPubMed
66Routledge, PA, Chapman, PH, Davies, DM, Rawlins, MD. Factors affecting warfarin requirements – a prospective population study. Eur J Clin Pharmac 1979; 15: 319–22.CrossRefGoogle ScholarPubMed
67Routledge, PA, Chapman, PH, Davies, DM, Rawlins, MD. Pharmacokinetics and pharmacodynamics of warfarin at steady state. Br J Clin Pharmacol 1979; 8: 243–7.CrossRefGoogle ScholarPubMed
68British Thoracic Society Guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58: 470–4.CrossRefGoogle Scholar
69Leacche, M, Unic, D, Goldhaber, SZ et al. Modern surgical treatment of massive pulmonary embolism: results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg 2005; 129: 1018–23.CrossRefGoogle ScholarPubMed
70Gross, PL, Weitz, JI. New anticoagulants for treatment of venous thromboembolism. Arterioscler Thromb Vasc Biol 2008; 28: 380–6.CrossRefGoogle ScholarPubMed
71Eriksson, BI, Borris, LC, Friedman, RJ et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358: 2765–75.CrossRefGoogle ScholarPubMed
72Lassen, MR, Ageno, W, Borris, LC et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008; 358: 2776–86.CrossRefGoogle ScholarPubMed
73Buller, HR, Lensing, AW, Prins, MH et al. A dose-ranging study evaluating once-daily oral administration of the factor Xa inhibitor rivaroxaban in the treatment of patients with acute symptomatic deep vein thrombosis: the Einstein-DVT Dose-Ranging Study. Blood 2008; 112: 2242–7.CrossRefGoogle ScholarPubMed
74Venous thromboembolism – rivaroxaban. NICE technology appraisal. Accessed on 22/01/09 from: http://www.nice.org.uk/Guidance/TA/Wave17/15Google Scholar
75Pradaxa. EPARs for authorized medicinal products for human use. EMEA. Accessed on 17/05/08 from: http://www.emea.europa.eu/humandocs/Humans/EPAR/pradaxa/pradaxa.htmGoogle Scholar
76TA157 Venous thromboembolism – dabigatran: guidance. NICE technology appraisal. Accessed on 22/01/09 from: http://www.nice.org.uk/guidance/index.jsp?action=download&o=42033Google Scholar