Nicolas Faller1, Andreas Limacher2, Marie Méan3, Marc Righini4, Markus Aschwanden5, Jürg Hans Beer6, Beat Frauchiger7, Josef Osterwalder8, Nils Kucher9, Bernhard Lämmle10, Jacques Cornuz11, Anne Angelillo-Scherrer12, Christian M Matter13, Marc Husmann14, Martin Banyai15, Daniel Staub5, Lucia Mazzolai16, Olivier Hugli17, Nicolas Rodondi18, Drahomir Aujesky18. 1. Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland. Electronic address: nicolas.faller@insel.ch. 2. Clinical Trials Unit Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine, University of Bern, Switzerland. 3. Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland; Division of Internal Medicine, Lausanne University Hospital, Switzerland. 4. Division of Angiology and Hemostasis, Geneva University Hospital, Switzerland. 5. Division of Angiology, Basel University Hospital, Switzerland. 6. Department of Internal Medicine, Cantonal Hospital of Baden, Switzerland. 7. Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Switzerland. 8. Department of Emergency Medicine, Cantonal Hospital of St Gallen, Switzerland. 9. Division of Angiology, Bern University Hospital, Switzerland. 10. University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany. 11. Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Switzerland. 12. University Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital, Switzerland. 13. Center for Molecular Cardiology, University of Zurich, and Clinic for Cardiology, University Heart Center, Zurich University Hospital, Switzerland. 14. Division of Angiology, Zurich University Hospital, Switzerland. 15. Division of Angiology, Cantonal Hospital of Lucerne, Switzerland. 16. Division of Angiology, Lausanne University Hospital, Switzerland. 17. Emergency Department, Lausanne University Hospital, Switzerland. 18. Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland.
Abstract
BACKGROUND: Long-term predictors and causes of death are understudied in elderly patients with acute venous thromboembolism. METHODS: We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was overall mortality. We explored the association between patient baseline characteristics and mortality, adjusting for other baseline variables and periods of anticoagulation as a time-varying covariate. Causes of death over time were adjudicated by a blinded, independent committee. RESULTS: The median age was 75 years. During a median follow-up period of 30 months, 206 patients (21%) died. Independent predictors of overall mortality were age (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.05-1.65, per decade), active cancer (HR, 5.80; 95% CI, 4.22-7.97), systolic blood pressure <100 mm Hg (HR, 2.77; 95% CI, 1.56-4.92), diabetes mellitus (HR, 1.50; 95% CI, 1.02-2.22), low physical activity level (HR, 1.92; 95% CI, 1.38-2.66), polypharmacy (HR, 1.41; 95% CI, 1.01-1.96), anemia (HR, 1.48; 95% CI, 1.07-2.05), high-sensitivity C-reactive protein >40 mg/L (HR, 1.88; 95% CI, 1.36-2.60), ultra-sensitive troponin >14 pg/mL (HR, 1.54; 95% CI, 1.06-2.25), and D-dimer >3000 ng/mL (HR, 1.45; 95% CI, 1.04-2.01). Cancer (34%), pulmonary embolism (18%), infection (17%), and bleeding (6%) were the most common causes of death. CONCLUSIONS: Elderly patients with acute venous thromboembolism have a substantial long-term mortality, and several factors, including polypharmacy and a low physical activity level, are associated with long-term mortality. Cancer, pulmonary embolism, infections, and bleeding are the most common causes of death in the elderly with venous thromboembolism.
BACKGROUND: Long-term predictors and causes of death are understudied in elderly patients with acute venous thromboembolism. METHODS: We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was overall mortality. We explored the association between patient baseline characteristics and mortality, adjusting for other baseline variables and periods of anticoagulation as a time-varying covariate. Causes of death over time were adjudicated by a blinded, independent committee. RESULTS: The median age was 75 years. During a median follow-up period of 30 months, 206 patients (21%) died. Independent predictors of overall mortality were age (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.05-1.65, per decade), active cancer (HR, 5.80; 95% CI, 4.22-7.97), systolic blood pressure <100 mm Hg (HR, 2.77; 95% CI, 1.56-4.92), diabetes mellitus (HR, 1.50; 95% CI, 1.02-2.22), low physical activity level (HR, 1.92; 95% CI, 1.38-2.66), polypharmacy (HR, 1.41; 95% CI, 1.01-1.96), anemia (HR, 1.48; 95% CI, 1.07-2.05), high-sensitivity C-reactive protein >40 mg/L (HR, 1.88; 95% CI, 1.36-2.60), ultra-sensitive troponin >14 pg/mL (HR, 1.54; 95% CI, 1.06-2.25), and D-dimer >3000 ng/mL (HR, 1.45; 95% CI, 1.04-2.01). Cancer (34%), pulmonary embolism (18%), infection (17%), and bleeding (6%) were the most common causes of death. CONCLUSIONS: Elderly patients with acute venous thromboembolism have a substantial long-term mortality, and several factors, including polypharmacy and a low physical activity level, are associated with long-term mortality. Cancer, pulmonary embolism, infections, and bleeding are the most common causes of death in the elderly with venous thromboembolism.
Authors: Liu Tong; Jun Zheng; You-Cong Zhang; Kai Zhu; Hui-Qiang Gao; Kai Zhang; Xiu-Feng Jin; Shang-Dong Xu Journal: Front Physiol Date: 2020-01-21 Impact factor: 4.566
Authors: S M Silvis; E Reinstra; S Hiltunen; E Lindgren; M R Heldner; M Mansour; M Ghiasian; K Jood; S M Zuurbier; A E Groot; M Arnold; M A Barboza; A Arauz; J Putaala; T Tatlisumak; J M Coutinho Journal: Eur J Neurol Date: 2020-01-24 Impact factor: 6.089