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[Thromboembolic disease in patients aged 80 and over. Diagnostic and therapeutic strategies]
Insights
Elderly patients over 80 with deep vein thrombosis (DVT) often present with pulmonary embolism (PE), with ultrasound being key for diagnosis. Treatment is possible, but high mortality persists in this age group.
Area of Science:
- Cardiology
- Vascular Medicine
- Geriatrics
Context:
- Retrospective study of 50 patients aged 80+ with lower limb deep vein thrombosis (DVT).
- Patients hospitalized in a cardiology department.
- Focus on diagnostic value and treatment outcomes in the elderly.
Purpose:
- Assess diagnostic utility of ultrasound and clinical parameters for DVT and pulmonary embolism (PE) in patients 80 and over.
- Evaluate treatment results for thrombo-embolic disease in this geriatric population.
- Analyze the incidence and presentation of DVT and PE in elderly patients.
Summary:
- High DVT prevalence (76%) and PE incidence (52.1%) observed, increasing with age.
- One-third of DVTs were asymptomatic, presenting as PE; edema was a common sign.
- Atrial fibrillation strongly associated with PE (90%). Venous Echo-Doppler is crucial for DVT diagnosis.
- Cardiac Echo-Doppler aids PE diagnosis in significant vascular obstruction (>40%).
- Thrombolytic therapy is an option for life-threatening PE in patients over 80.
- Overall hospital mortality remains high (10.4%), often due to untreated PE.
Impact:
- Highlights the diagnostic importance of Venous Echo-Doppler for DVT in the elderly.
- Underscores the high risk of PE in elderly DVT patients, often asymptomatic.
- Suggests continued consideration of thrombolytic therapy for severe PE in octogenarians.
- Emphasizes the need for improved management strategies to reduce mortality in this vulnerable population.
Abstract:
The aim of this retrospective study of 50 deep vein thromboses (DVT) of the lower limbs in patients aged 80 and over (35 women, including 2 with bilateral DVT and 13 men), mean age 83.37 +/- 2.72, hospitalised in a department of cardiology, was to assess the diagnostic value of ultrasound investigations, clinical parameters and results of treatment of thrombo-embolic disease in this age group. High DVT were found in 76 per cent of cases and pulmonary embolism occurred in 52.1 per cent of cases, its incidence increasing with age. One third of DVT were asymptomatic and presented as pulmonary embolism, the predominant clinical feature being edema in the absence of other signs. The existence of atrial fibrillation was associated in 90 per cent of cases with a pulmonary embolism. Venous Echo-Doppler is also the key investigation in the diagnosis of thrombo-embolic disease. Cardiac Echo-Doppler seems particularly useful in the diagnosis of pulmonary embolism when more than 40 per cent of the vascular bed is cut off. Thrombolytic treatment remains possible after the age of 80 in life-threatening situations. Overall hospital mortality remains high (10.4 per cent) and appears to be due chiefly to the onset of a pulmonary embolism which is not thrombolyzed since considered insufficiently serious or occurring in a situation in which fibrinolysis is theoretically contra-indicated.