Elderly Patients with Venous Thromboembolism: Insights from the RIETE Registry
Patrick Mismetti 1), Laurent Bertoletti 1), Isabelle Gouin 2) 3), Joseph Emmerich 4) 5), Manuel Monreal 6) 7)
1) Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne, INSERM CIC 1408 CHU de St-Etienne, INSERM UMR 1059, Université Jean Monnet, Saint-Etienne, France
2) Department of Laboratory Hematology, Pontchaillou University Hospital of Rennes, Rennes, France
3) Institut de Recherche en Santé, Environnement et Travail (IRSET)-Institut National de la Santé et de la Recherche Médicale (INSERM)-1085, University of Rennes, Rennes, France
4) Department of Vascular Medicine, Paris Saint-Joseph Hospital Group, University of Paris, 75014 Paris, France
5) INSERM CRESS UMR 1153, F-75005, Paris, France
6) Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain
7) CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
Abstract
Venous thromboembolism (VTE) presents a notable healthcare burden, particularly among the elderly, who experience increased risks and more severe complications. This review aims to use the extensive data from the RIETE registry, a comprehensive database on consecutive patients with VTE. We examine the clinical features, therapeutic approaches, and patient outcomes of VTE in elderly patients, compared to younger patients, offering a comprehensive understanding of management challenges and emphasizing the need for strategies that accommodate the unique challenges of this population.
Introduction
Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), emerges as a critical health concern with a disproportionately severe impact on the elderly. Its prevalence, escalating with age, highlights a pressing impact on the elderly: the annual incidence rate of VTE stands at approximately 1–2 cases per 1000 individuals in the general population [1,2], a figure that escalates markedly with advancing age [[3], [4], [5]]. This incidence rate is not merely a reflection of demographic aging but underscores a confluence of factors intrinsic to the geriatric population.
The advanced age group, notably those beyond the seventh decade, constitutes a substantial fraction of VTE patients [[6], [7], [8]]. Yet, despite their prominent representation among those affected, there remains a dearth of dedicated research dissecting how aging alters the presentation, management, and prognosis of VTE [6,[9], [10], [11]]. This gap in knowledge persists despite clear indications that advanced age correlates with worse outcomes, a pattern than can be tracked back to the amplifying effect of comorbidities and the waning of cardiopulmonary reserves [12,13].
Notably, the representation of the elderly in randomized clinical trials is scant, resulting in a limited understanding of how age-specific responses to VTE treatments, both pharmacological and interventional, manifest. This is a significant shortfall, considering the intricate challenges that pervade the management of VTE in this age group. The complexity is multifaceted: heightened morbidity, the fragility associated with geriatric syndromes, the intricacy of polypharmacy, and the alterations in pharmacokinetics attributed to physiological changes with aging all converge to create a labyrinthine clinical scenario [[13], [14], [15], [16]].
Such realities underscore the pressing need for a nuanced exploration of VTE management tailored to the elderly. This endeavor is critical, not only to mitigate the immediate challenges but to pave the way for improved clinical outcomes and quality of life for these patients. Thus, our review strives to dissect these intricacies, integrating contemporary research findings to craft a narrative that both informs and guides enhanced clinical practice.