90岁及以上患者的抗凝血和静脉血栓塞栓症:来自RIETE注册表的数据
Ludovic Lafaie1,2, Géraldine Poenou3, Olivier Hanon4
1Département de Gérontologie Clinique, CHU de Saint-Etienne, Saint-Etienne, France.
Journal of the American Geriatrics Society
|October 10, 2023
概括
患有静脉血栓塞栓症 (VTE) 的90岁及以上的老年患者与年轻患者相比,具有不同的特征和结果. 管理策略可能需要根据VTE是否呈现为肺栓塞或深静脉血栓症来定制.
科学领域:
- 老年医学 老年医学
- 心脏病学 心脏病学
- 血液学 血液学 血液学
背景情况:
- 高龄 (≥90岁) 是静脉血栓栓塞 (VTE) 的重要危险因素.
- 90岁以上的患者在抗凝固药治疗的临床试验中代表性不足.
- 由于这些老年人具有独特的临床特征,了解这种老年人群的VTE管理至关重要.
研究的目的:
- 为了比较90岁以上的VTE患者的临床特征,治疗方法和结果,与90岁以下的患者进行比较.
- 分析VTE复发,出血事件和抗凝药治疗前3个月内的死亡率.
- 为了确定基于VTE呈现在非常老年人的管理方法的潜在差异.
主要方法:
- 分析来自Registro Informatizado Enfermedad TromboEmblica (RIETE) 全球观测注册表的数据.
- 包括从2001年1月到2022年10月客观证实急性VTE的患者.
- 患者人口统计学,并发症和年龄组之间的治疗结果的比较 (≥90 vs <90岁).
主要成果:
- 在96,701名VTE患者中,3.4%的患者年龄≥90岁.
- 年龄较大的患者 (≥90岁) 患不动,心力衰竭,贫血,功能衰竭和痴呆率较高.
- 在前3个月,分别在26,116名和564名年龄≥90岁的患者中观察到VTE复发,严重出血和死亡.
- 在患有肺栓塞的老年患者中,PE死亡率 (76) 超过了致命出血死亡率 (19);对于深静脉血栓塞,出血死亡率 (11) 超过了DVT死亡率 (2).
结论:
- 在90岁以上的患者中,抗凝固药治疗的结果可能会根据VTE的初始表现 (肺栓塞与深静脉血栓塞) 而有所不同.
- 这表明,在这个非常老年人群中,可能需要针对VTE呈现量身定制的独特管理策略.
- 进一步的临床试验是有必要的,以优化抗凝剂的持续时间和管理非常老年VTE患者基于他们的初始呈现,以减少死亡率.
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