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Venous Thromboembolism in the Elderly

  • Pulmonology and Respiratory Care (AI Musani and E Folch, Section Editors)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Aging is a major risk factor for venous thromboembolism. Compared to the general population, the elderly have a much higher 1-year mortality from venous thromboembolism (VTE). Clinical presentation of VTE in the elderly tends to be different, with atypical symptoms being more common than in the general population. Diagnostic work-up starts with establishing a VTE pretest probability followed by D-dimer testing for patients with low pretest probability and confirmatory testing for patients with high pretest probability of VTE. The age-adjusted D-dimer cutoffs are associated with a higher specificity without compromising the test’s sensitivity. Anticoagulation is the cornerstone of VTE therapy. The use of novel oral anticoagulants is safe in elderly patients and is associated with a decreased risk of bleeding.

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Abbreviations

VTE:

Venous thromboembolism

PE:

Pulmonary embolism

DVT:

Deep venous thrombosis

COPD:

Chronic obstructive pulmonary disease

CTA:

Computerized tomographic angiography

CIN:

Contrast-induced nephropathy

PTS:

Postthrombotic syndrome

VKA:

Vitamin K antagonists

LMWH:

Low-molecular-weight heparin

UFH:

Unfractionated heparin

INR:

International normalized ratio

NOAC:

Novel oral anticoagulant

ACCP:

American College of Chest Physicians

IVC:

Inferior vena cava

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sellier E, Labarere J, Sevestre M-A, Belmin J, Thiel H, Couturier P, et al. Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France. J Am Geriatr Soc. 2008;56:224–30.

    Article  PubMed  Google Scholar 

  2. Weill-Engerer S, Meaume S, Lahlou A, Piette F, Saint-Jean O, Sachet A, et al. Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study. J Am Geriatr Soc. 2004;52:1299–304.

    Article  PubMed  Google Scholar 

  3. Righini M, Goehring C, Bounameaux H, Perrier A. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med. 2000;109:357–61.

    Article  CAS  PubMed  Google Scholar 

  4. Montagnana M, Favaloro EJ, Franchini M, Guidi GC, Lippi G. The role of ethnicity, age and gender in venous thromboembolism. J Thromb Thrombolysis. 2010;29:489–96.

    Article  PubMed  Google Scholar 

  5. Kim DY, Kobayashi L, Barmparas G, Fortlage D, Curry T, Coimbra R. Venous thromboembolism in the elderly: the result of comorbid conditions or a consequence of injury? J Trauma Acute Care Surg. 2012;72:1286–91.

    Article  PubMed  Google Scholar 

  6. Rosendaal FR, VAN Hylckama Vlieg A, Doggen CJM. Venous thrombosis in the elderly. J Thromb Haemost JTH. 2007;5 Suppl 1:310–7.

    Article  PubMed  Google Scholar 

  7. Franchini M. Hemostasis and aging. Crit Rev Oncol Hematol. 2006;60:144–51.

    Article  PubMed  Google Scholar 

  8. Abbate R, Prisco D, Rostagno C, Boddi M, Gensini GF. Age-related changes in the hemostatic system. Int J Clin Lab Res. 1993;23:1–3.

    Article  CAS  PubMed  Google Scholar 

  9. Mari D, Mannucci PM, Coppola R, Bottasso B, Bauer KA, Rosenberg RD. Hypercoagulability in centenarians: the paradox of successful aging. Blood. 1995;85:3144–9.

    CAS  PubMed  Google Scholar 

  10. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160:809–15.

    Article  CAS  PubMed  Google Scholar 

  11. Spencer FA, Gurwitz JH, Schulman S, Linkins L-A, Crowther MA, Ginsberg JS, et al. Venous thromboembolism in older adults: a community-based study. Am J Med. 2014;127:530–7. e3.

    Article  PubMed  Google Scholar 

  12. Heit JA, Melton LJ, Lohse CM, Petterson TM, Silverstein MD, Mohr DN, et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc. 2001;76:1102–10.

    Article  CAS  PubMed  Google Scholar 

  13. Blom JW, Osanto S, Rosendaal FR. The risk of a venous thrombotic event in lung cancer patients: higher risk for adenocarcinoma than squamous cell carcinoma. J Thromb Haemost JTH. 2004;2:1760–5.

    Article  CAS  PubMed  Google Scholar 

  14. Rickles FR, Falanga A. Molecular basis for the relationship between thrombosis and cancer. Thromb Res. 2001;102:V215–24.

    Article  CAS  PubMed  Google Scholar 

  15. Zanocchi M, Risso R, Maero B, Aimar T, Giona E, Francisetti F, et al. Deep venous thrombosis and cancer in the elderly. Minerva Med. 2001;92:307–13.

    CAS  PubMed  Google Scholar 

  16. Furie B, Furie BC. Cancer-associated thrombosis. Blood Cells Mol Dis. 2006;36:177–81.

    Article  CAS  PubMed  Google Scholar 

  17. Tesselaar MET, Romijn FPHTM, Van Der Linden IK, Prins FA, Bertina RM, Osanto S. Microparticle-associated tissue factor activity: a link between cancer and thrombosis? J Thromb Haemost JTH. 2007;5:520–7.

    Article  CAS  PubMed  Google Scholar 

  18. Fimognari FL, Repetto L, Moro L, Gianni W, Incalzi RA. Age, cancer and the risk of venous thromboembolism. Crit Rev Oncol Hematol. 2005;55:207–12.

    Article  PubMed  Google Scholar 

  19. Eikelboom JW, Quinlan DJ, Douketis JD. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet Lond Engl. 2001;358:9–15.

    Article  CAS  Google Scholar 

  20. Lieberman DV, Lieberman D. Proximal deep vein thrombosis after hip fracture surgery in elderly patients despite thromboprophylaxis. Am J Phys Med Rehabil Assoc Acad Physiatr. 2002;81:745–50.

    Article  Google Scholar 

  21. López-Jiménez L, Montero M, González-Fajardo JA, Arcelus JI, Suárez C, Lobo JL, et al. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica. 2006;91:1046–51.

    PubMed  Google Scholar 

  22. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost. 2001;86:452–63.

    CAS  PubMed  Google Scholar 

  23. Kokturk N, Oguzulgen IK, Demir N, Demirel K, Ekim N. Differences in clinical presentation of pulmonary embolism in older vs younger patients. Circ J Off J Jpn Circ Soc. 2005;69:981–6.

    Google Scholar 

  24. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet Lond Engl. 1999;353:1386–9.

    Article  CAS  Google Scholar 

  25. Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151:933–8.

    Article  PubMed  Google Scholar 

  26. Kniffin WD, Baron JA, Barrett J, Birkmeyer JD, Anderson FA. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994;154:861–6.

    Article  PubMed  Google Scholar 

  27. Weberová D, Weber P, Kubesová H, Meluzínová H, Polcarová V, Ambrosová P, et al. Occurrence of pulmonary embolism among 260 in-patients of acute geriatric department aged 65+ years in 2005-2010. Adv Gerontol Uspekhi Gerontol Ross Akad Nauk Gerontol Obshchestvo. 2012;25:506–12.

    Google Scholar 

  28. Kammoun S, Gold G, Bouras C, Giannakopoulos P, McGee W, Herrmann F, et al. Immediate causes of death of demented and non-demented elderly. Acta Neurol Scand Suppl. 2000;176:96–9.

    Article  CAS  PubMed  Google Scholar 

  29. Attems J, Arbes S, Böhm G, Böhmer F, Lintner F. The clinical diagnostic accuracy rate regarding the immediate cause of death in a hospitalized geriatric population; an autopsy study of 1594 patients. Wien Med Wochenschr 1946. 2004;154:159–62.

    Article  Google Scholar 

  30. Ceccarelli E, Masotti L, Barabesi L, Forconi S, Cappelli R. Pulmonary embolism in very old patients. Aging Clin Exp Res. 2003;15:117–22.

    Article  PubMed  Google Scholar 

  31. Gisselbrecht M, Diehl JL, Meyer G, Collignon MA, Sors H. Clinical presentation and results of thrombolytic therapy in older patients with massive pulmonary embolism: a comparison with non-elderly patients. J Am Geriatr Soc. 1996;44:189–93.

    Article  CAS  PubMed  Google Scholar 

  32. Stein PD, Gottschalk A, Saltzman HA, Terrin ML. Diagnosis of acute pulmonary embolism in the elderly. J Am Coll Cardiol. 1991;18:1452–7.

    Article  CAS  PubMed  Google Scholar 

  33. Lasch H, Castell DO, Castell JA. Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension. Am J Physiol. 1997;272:G1–3.

    CAS  PubMed  Google Scholar 

  34. Timmons S, Kingston M, Hussain M, Kelly H, Liston R. Pulmonary embolism: differences in presentation between older and younger patients. Age Ageing. 2003;32:601–5.

    Article  PubMed  Google Scholar 

  35. Ter Braak GI. Old, short of breath and confused; delirium as a manifestation of pulmonary embolism in geriatric patients. Ned Tijdschr Geneeskd. 1998;142:1046.

    PubMed  Google Scholar 

  36. Soysal P, Isik AT. Hypoactive delirium caused by pulmonary embolus in an elderly adult. J Am Geriatr Soc. 2014;62:586–7.

    Article  PubMed  Google Scholar 

  37. Tan WL, Chel VG, Rooijers-Rebel M, Hennemann G. Multiple pulmonary embolisms in nursing home patients recognizable by alertness to certain aspecific symptoms. Ned Tijdschr Geneeskd. 1995;139:2487–91.

    CAS  PubMed  Google Scholar 

  38. Taubman LB, Silverstone FA. Autopsy proven pulmonary embolism among the institutionalized elderly. J Am Geriatr Soc. 1986;34:752–6.

    Article  CAS  PubMed  Google Scholar 

  39. Piazza G, Seddighzadeh A, Goldhaber SZ. Deep-vein thrombosis in the elderly. Clin Appl Thromb Off J Int Acad Clin Appl Thromb. 2008;14:393–8.

    Article  Google Scholar 

  40. Stain M, Schönauer V, Minar E, Bialonczyk C, Hirschl M, Weltermann A, et al. The post-thrombotic syndrome: risk factors and impact on the course of thrombotic disease. J Thromb Haemost JTH. 2005;3:2671–6.

    Article  CAS  PubMed  Google Scholar 

  41. Tick LW, Doggen CJM, Rosendaal FR, Faber WR, Bousema MT, Mackaay AJC, et al. Predictors of the post-thrombotic syndrome with non-invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis. J Thromb Haemost JTH. 2010;8:2685–92.

    Article  CAS  PubMed  Google Scholar 

  42. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83:416–20.

    CAS  PubMed  Google Scholar 

  43. Le Gal G, Righini M, Roy P-M, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144:165–71.

    Article  PubMed  Google Scholar 

  44. Perrier A, Roy P-M, Sanchez O, Le Gal G, Meyer G, Gourdier A-L, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352:1760–8.

    Article  CAS  PubMed  Google Scholar 

  45. Quiroz R, Kucher N, Zou KH, Kipfmueller F, Costello P, Goldhaber SZ, et al. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA. 2005;293:2012–7.

    Article  CAS  PubMed  Google Scholar 

  46. Van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–9.

    Article  PubMed  Google Scholar 

  47. Hirsh J, Lee AYY. How we diagnose and treat deep vein thrombosis. Blood. 2002;99:3102–10.

    Article  CAS  PubMed  Google Scholar 

  48. Ageno W, Camporese G, Riva N, Iotti M, Bucherini E, Righini M, et al. Analysis of an algorithm incorporating limited and whole-leg assessment of the deep venous system in symptomatic outpatients with suspected deep-vein thrombosis (PALLADIO): a prospective, multicentre, cohort study. Lancet Haematol. 2015;2:e474–80. Study has proposed a new algorithm using which some of the patients with suspected DVT can be safely worked up just by limited lower extremity ultrasounds.

    Article  PubMed  Google Scholar 

  49. Righini M, Nendaz M, Le Gal G, Bounameaux H, Perrier A. Influence of age on the cost-effectiveness of diagnostic strategies for suspected pulmonary embolism. J Thromb Haemost JTH. 2007;5:1869–77.

    Article  CAS  PubMed  Google Scholar 

  50. Woller SC, Stevens SM, Adams DM, Evans RS, Lloyd JF, Snow GL, et al. Assessment of the safety and efficiency of using an age-adjusted D-dimer threshold to exclude suspected pulmonary embolism. Chest. 2014;146:1444–51.

    Article  PubMed  Google Scholar 

  51. Righini M, Van Es J, Den Exter PL, Roy P-M, Verschuren F, Ghuysen A, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311:1117–24. Largest trial evaluating the utility of age adjusted D-dimer levels for suspected PE.

    Article  CAS  PubMed  Google Scholar 

  52. Schouten HJ, Geersing GJ, Koek HL, Zuithoff NPA, Janssen KJM, Douma RA, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ. 2013;346:f2492. Meta-analysis which further substantiates the findings of ADJUST-PE study.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Taylor C, Sultan L. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: the use of age-related D-dimers to rule out deep vein thrombosis. Emerg Med J EMJ. 2015;32:747–9.

    Article  PubMed  Google Scholar 

  54. Zhang S, Li J, Liu C, Tan G, Cao X, Wang J. The value of age-adjusted D-dimer cut-off value in diagnosing deep vein thrombosis in elderly patients. Zhonghua Xin Xue Guan Bing Za Zhi. 2013;41:945–9. A large trial that validated use of age adjusted D-dimer levels for suspected DVTs.

    PubMed  Google Scholar 

  55. Mitchell AM, Jones AE, Tumlin JA, Kline JA. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med Off J Soc Acad Emerg Med. 2012;19:618–25.

    Article  Google Scholar 

  56. Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 2004;44:1780–5.

    Article  PubMed  Google Scholar 

  57. Kreidy R, Stephan E, Salameh P, Waked M. Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism. Vasc Health Risk Manag. 2011;7:585–9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Matzdorff AC, Green D. Deep vein thrombosis and pulmonary embolism: prevention, diagnosis, and treatment. Geriatrics. 1992;47:48–52. 55–7, 62–3.

    CAS  PubMed  Google Scholar 

  59. Eze AR, Comerota AJ, Kerr RP, Harada RN, Domeracki F. Is venous duplex imaging an appropriate initial screening test for patients with suspected pulmonary embolism? Ann Vasc Surg. 1996;10:220–3.

    Article  CAS  PubMed  Google Scholar 

  60. Chopard P, Dörffler-Melly J, Hess U, Wuillemin WA, Hayoz D, Gallino A, et al. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement. J Intern Med. 2005;257:352–7.

    Article  CAS  PubMed  Google Scholar 

  61. Bratzler DW, Raskob GE, Murray CK, Bumpus LJ, Piatt DS. Underuse of venous thromboembolism prophylaxis for general surgery patients: physician practices in the community hospital setting. Arch Intern Med. 1998;158:1909–12.

    Article  CAS  PubMed  Google Scholar 

  62. Di Minno G, Tufano A. Challenges in the prevention of venous thromboembolism in the elderly. J Thromb Haemost JTH. 2004;2:1292–8.

    Article  PubMed  Google Scholar 

  63. Spyropoulos AC, Merli G. Management of venous thromboembolism in the elderly. Drugs Aging. 2006;23:651–71.

    Article  CAS  PubMed  Google Scholar 

  64. Alikhan R, Cohen AT, Combe S, Samama MM, Desjardins L, Eldor A, et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis Int J Haemost Thromb. 2003;14:341–6.

    Article  CAS  Google Scholar 

  65. Dahan R, Houlbert D, Caulin C, Cuzin E, Viltart C, Woler M, et al. Prevention of deep vein thrombosis in elderly medical in-patients by a low molecular weight heparin: a randomized double-blind trial. Haemostasis. 1986;16:159–64.

    CAS  PubMed  Google Scholar 

  66. Bergmann JF, Neuhart E. A multicenter randomized double-blind study of enoxaparin compared with unfractionated heparin in the prevention of venous thromboembolic disease in elderly in-patients bedridden for an acute medical illness. The Enoxaparin in Medicine Study Group. Thromb Haemost. 1996;76:529–34.

    CAS  PubMed  Google Scholar 

  67. Mismetti P, Laporte-Simitsidis S, Tardy B, Cucherat M, Buchmüller A, Juillard-Delsart D, et al. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thromb Haemost. 2000;83:14–9.

    CAS  PubMed  Google Scholar 

  68. Rodríguez-Mañas L, Gómez-Huelgas R, Veiga-Fernández F, Ruiz GM, González JM, ANCIANOS Investigators. Thromboprophylaxis with the low-molecular-weight heparin bemiparin sodium in elderly medical patients in usual clinical practice: the ANCIANOS study. Clin Drug Investig. 2010;30:337–45.

    Article  PubMed  Google Scholar 

  69. Kucher N, Leizorovicz A, Vaitkus PT, Cohen AT, Turpie AGG, Olsson C-G, et al. Efficacy and safety of fixed low-dose dalteparin in preventing venous thromboembolism among obese or elderly hospitalized patients: a subgroup analysis of the PREVENT trial. Arch Intern Med. 2005;165:341–5.

    Article  CAS  PubMed  Google Scholar 

  70. Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ. 2006;332:325–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Buresly K, Eisenberg MJ, Zhang X, Pilote L. Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction. Arch Intern Med. 2005;165:784–9.

    Article  CAS  PubMed  Google Scholar 

  72. Fehrman-Ekholm I, Skeppholm L. Renal function in the elderly (>70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol. 2004;38:73–7.

    Article  CAS  PubMed  Google Scholar 

  73. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7.

    Article  CAS  PubMed  Google Scholar 

  74. Di Minno G, Tufano A, Cerbone AM. Antithrombotic drugs for older subjects. Guidelines formulated jointly by the Italian Societies of Haemostasis and Thrombosis (SISET) and of Gerontology and Geriatrics (SIGG). Nutr Metab Cardiovasc Dis NMCD. 2001;11:41–62.

    PubMed  Google Scholar 

  75. Levine M, Gent M, Hirsh J, Leclerc J, Anderson D, Weitz J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med. 1996;334:677–81.

    Article  CAS  PubMed  Google Scholar 

  76. Spyropoulos AC, Hurley JS, Ciesla GN, de Lissovoy G. Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin. Chest. 2002;122:108–14.

    Article  PubMed  Google Scholar 

  77. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:204S–33.

    Article  CAS  PubMed  Google Scholar 

  78. Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med. 2005;165:1095–106.

    Article  CAS  PubMed  Google Scholar 

  79. Vogel T, Coriol V, Kaltenbach G, Kiesmann M, Berthel M. Prospective study of oral anticoagulation control in 110 very elderly hospitalized patients and of risk factors for poor control. Presse Médicale Paris Fr 1983. 2008;37:1723–30.

    Google Scholar 

  80. Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989;87:144–52.

    Article  CAS  PubMed  Google Scholar 

  81. Launbjerg J, Egeblad H, Heaf J, Nielsen NH, Fugleholm AM, Ladefoged K. Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients. J Intern Med. 1991;229:351–5.

    Article  CAS  PubMed  Google Scholar 

  82. Van der Meer FJ, Rosendaal FR, Vandenbroucke JP, Briët E. Bleeding complications in oral anticoagulant therapy. An analysis of risk factors. Arch Intern Med. 1993;153:1557–62.

    Article  PubMed  Google Scholar 

  83. Sardar P, Chatterjee S, Chaudhari S, Lip GYH. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc. 2014;62:857–64. First study that evaluated the safety of NOACs in elderly patients.

    Article  PubMed  Google Scholar 

  84. Legrand M, Mateo J, Aribaud A, Ginisty S, Eftekhari P, Huy PTB, et al. The use of dabigatran in elderly patients. Arch Intern Med. 2011;171:1285–6.

    Article  PubMed  Google Scholar 

  85. Harper P, Young L, Merriman E. Bleeding risk with dabigatran in the frail elderly. N Engl J Med. 2012;366:864–6.

    Article  CAS  PubMed  Google Scholar 

  86. Wychowski MK, Kouides PA. Dabigatran-induced gastrointestinal bleeding in an elderly patient with moderate renal impairment. Ann Pharmacother. 2012;46:e10.

    Article  PubMed  Google Scholar 

  87. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499–510.

    Article  Google Scholar 

  88. EINSTEIN–PE Investigators, Büller HR, Prins MH, Lensin AWA, Decousus H, Jacobson BF, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366:1287–97.

    Article  Google Scholar 

  89. Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368:513–23.

    Article  CAS  PubMed  Google Scholar 

  90. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368:699–708.

    Article  CAS  PubMed  Google Scholar 

  91. Schulman S, Kearon C, Kakkar AK, Schellong S, Eriksson H, Baanstra D, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013;368:709–18.

    Article  CAS  PubMed  Google Scholar 

  92. CHEST issues new antithrombotic guideline update for treatment of VTE disease [Internet]. Am Coll Chest Physicians. [cited 2016 Jan 11]. Available from: https://www.chestnet.org/News/Press-Releases/2016/01/AT10-VTE. Recent update issued by ACCP, recommending the use of NOACs over VKAs for the management of non-cancer related VTE. It also recommended against the routine use of compression stockings for the prevention of PTS.

  93. Sardar P, Chatterjee S, Herzog E, Pekler G, Mushiyev S, Pastori LJ, et al. New oral anticoagulants in patients with cancer: current state of evidence. Am J Ther. 2015;22:460–8.

    Article  PubMed  Google Scholar 

  94. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. De Bonis S, Rendina D, Vargas G, Di Minno D, Piedimonte V, Gallotta G, et al. Predictors of in-hospital and long-term clinical outcome in elderly patients with massive pulmonary embolism receiving thrombolytic therapy. J Am Geriatr Soc. 2008;56:2273–7.

    Article  PubMed  Google Scholar 

  96. Prandoni P, Lensing AWA, Prins MH, Frulla M, Marchiori A, Bernardi E, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med. 2004;141:249–56.

    Article  PubMed  Google Scholar 

  97. Kahn SR. How I treat postthrombotic syndrome. Blood. 2009;114:4624–31.

    Article  CAS  PubMed  Google Scholar 

  98. Cohen JM, Akl EA, Kahn SR. Pharmacologic and compression therapies for postthrombotic syndrome: a systematic review of randomized controlled trials. Chest. 2012;141:308–20.

    Article  CAS  PubMed  Google Scholar 

  99. Mismetti P, Laporte S, Pellerin O, Ennezat P-V, Couturaud F, Elias A, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313:1627–35. Recent trial that demonstrated no added benefit of using IVC filters along with anticoagulation for the prevention of recurrent PEs.

    Article  PubMed  Google Scholar 

  100. Arnold TE, Karabinis VD, Mehta V, Dupont EL, Matsumoto T, Kerstein MD. Potential of overuse of the inferior vena cava filter. Surg Gynecol Obstet. 1993;177:463–7.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk St, 15th Floor, Chicago, IL, 60612, USA

    Muhammad Sajawal Ali

  2. Division of Respirology, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave. 9N 941, Toronto, ON, M5G 2N2, Canada

    Kasia Czarnecka-Kujawa

Authors
  1. Muhammad Sajawal Ali
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  2. Kasia Czarnecka-Kujawa
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Correspondence to Kasia Czarnecka-Kujawa.

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Muhammad Sajawal Ali and Kasia Czarnecka-Kujawa declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pulmonology and Respiratory Care

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Ali, M.S., Czarnecka-Kujawa, K. Venous Thromboembolism in the Elderly. Curr Geri Rep 5, 132–139 (2016). https://doi.org/10.1007/s13670-016-0163-z

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  • DOI: https://doi.org/10.1007/s13670-016-0163-z

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