BACKGROUND: The risk of patients dying of pulmonary embolism (PE) or bleeding during the treatment of deep vein thrombosis (DVT), and whether these risks are influenced by patient age, has not been thoroughly studied. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to assess the risk of fatal PE and fatal bleeding in 16,199 patients with lower limb DVT (without symptomatic PE at the time of inclusion) during the 3 months after diagnosis, with patients categorized according to age. RESULTS: During the 3 months of anticoagulant treatment, there were 31 fatal PEs (0.19%) and 83 fatal hemorrhages (0.51%). During the first 7 days of therapy, the frequency of fatal PEs was similar to that of fatal bleeding (12 vs 14 deaths, respectively; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.39-1.87). However, from days 8 to 90, the frequency of fatal bleeding was greater than that of fatal PE (69 vs 19 deaths; OR, 3.64; 95% CI, 2.22-6.20). The higher frequency of fatal bleeding compared with fatal PE from days 8 to 90 appeared to be confined to patients who were aged ≥ 60 years. Multivariate analysis showed that patient age was independently associated with an increased risk of death from bleeding during the first 3 months: every 10 years the OR increased by 1.37 (95% CI, 1.12-1.67). CONCLUSIONS: During the first week of treatment, the risk of fatal bleeding and fatal PE were similar. Then, particularly in patients who were aged ≥ 60 years, the risk of dying from bleeding exceeded the risk of dying from PE.
BACKGROUND: The risk of patients dying of pulmonary embolism (PE) or bleeding during the treatment of deep vein thrombosis (DVT), and whether these risks are influenced by patient age, has not been thoroughly studied. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to assess the risk of fatal PE and fatal bleeding in 16,199 patients with lower limb DVT (without symptomatic PE at the time of inclusion) during the 3 months after diagnosis, with patients categorized according to age. RESULTS: During the 3 months of anticoagulant treatment, there were 31 fatal PEs (0.19%) and 83 fatal hemorrhages (0.51%). During the first 7 days of therapy, the frequency of fatal PEs was similar to that of fatal bleeding (12 vs 14 deaths, respectively; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.39-1.87). However, from days 8 to 90, the frequency of fatal bleeding was greater than that of fatal PE (69 vs 19 deaths; OR, 3.64; 95% CI, 2.22-6.20). The higher frequency of fatal bleeding compared with fatal PE from days 8 to 90 appeared to be confined to patients who were aged ≥ 60 years. Multivariate analysis showed that patient age was independently associated with an increased risk of death from bleeding during the first 3 months: every 10 years the OR increased by 1.37 (95% CI, 1.12-1.67). CONCLUSIONS: During the first week of treatment, the risk of fatal bleeding and fatal PE were similar. Then, particularly in patients who were aged ≥ 60 years, the risk of dying from bleeding exceeded the risk of dying from PE.
Authors: Meritxell Mellado; Javier Trujillo-Santos; Behnood Bikdeli; David Jiménez; Manuel Jesús Núñez; Martin Ellis; Pablo Javier Marchena; Jerónimo Ramón Vela; Albert Clara; Farès Moustafa; Manuel Monreal Journal: Intern Emerg Med Date: 2019-05-03 Impact factor: 3.397
Authors: Isabelle Mahé; Raluca Sterpu; Laurent Bertoletti; Luciano López-Jiménez; Meritxell Mellado Joan; Javier Trujillo-Santos; Aitor Ballaz; Luis Manuel Hernández Blasco; Pablo Javier Marchena; Manuel Monreal Journal: PLoS One Date: 2015-06-15 Impact factor: 3.240
Authors: Angeles Blanco-Molina; Iolanda Enea; Telma Gadelha; Antonella Tufano; Alessandra Bura-Riviere; Pierpaolo Di Micco; Henri Bounameaux; José González; Jaume Villalta; Manuel Monreal Journal: Medicine (Baltimore) Date: 2014-10 Impact factor: 1.889
Authors: Dominique Farge; Javier Trujillo-Santos; Philippe Debourdeau; Alessandra Bura-Riviere; Eva Maria Rodriguez-Beltrán; Jose Antonio Nieto; Maria Luisa Peris; David Zeltser; Lucia Mazzolai; Adrian Hij; Manuel Monreal Journal: Medicine (Baltimore) Date: 2015-08 Impact factor: 1.817