[Hemorrhagic complications and thrombotic phenomena in oral anticoagulation of elderly patients]

To retrospectively analyze the hemorrhagic complications and thrombotic events associated with aging and the degree of anticoagulation in a series of ambulatory patients treated with acenocumarol and controlled in a specialized anticoagulant therapy unit.

A total of 1,613 ambulatory patients were studied. Patients were divided into two groups (group 1, 645 patients > 65 years old, mean age 71.7 +/- 4.5 years; INR, 2.1-2.8; group 2, 968 patients < or = 65 years, mean age 53.7 +/- 10 years; INR, 2.8-4.2) for a time period of twelve months. The prevalence of hemorrhagic complications and severity according to a validated international index (Bleeding Severity Index), as well as the thrombotic events occurred despite anticoagulation therapy.

Fifty-two hemorrhagic events (8/100 patients-year) were recorded in the older group (group 1). Twenty-six cases were considered banal episodes, 24 minor hemorrhages and two major hemorrhages. Ten patients (1.5/100 patients-year) had thrombotic complications. In the younger group (group 2) 150 bleeding episodes were recorded (15 patients-year), of which 11 were banal, 39 minor hemorrhages and no major hemorrhages. Only eight patients 0.8/100 patients-year) had thrombosis. The presence of local factors predisposing to bleeding was more common in group 1 (p < 0.001). Older patients had in general more complications than younger patients (p < 0.001), but no significant differences were observed between the occurrence of hemorrhages or thrombosis independently analyzed between both groups. The rate in the therapeutic range was greater among the youngest individuals (p < 0.05).

Our results support the idea that patients with advanced age can benefit from a less aggressive anticoagulation. A statistical trend was observed, although not significant, towards the presence of major hemorrhages and thrombosis in this group of patients. The presence of local or predisposing factors to hemorrhage (underlying disease and NSAIDs use) is more relevant in patients with advanced age.