Risk for Recurrence of Venous Thromboembolism Higher Among Younger Patients

Younger patients with venous thromboembolism (VTE) may be at higher risk for recurrence compared with older patients. These findings were published in the International Journal of Cardiology.

Instance of VTE have been increasing. Some published evidence has related VTE risk with age, however, there remains a paucity of data overall about the relationship between age and VTE outcomes and recurrence risk.

To better evaluate these relationships, data for this study were sourced from the COMMAND VTE (Contemporary Management and Outcomes in Patients With Venous Thromboembolism) registry, which is a multicenter cohort study conducted between 2010 and 2014 at 29 sites in Japan. For this study, patients (N=3027) with VTE were evaluated for outcomes on the basis of age. Recurrent VTE was defined as pulmonary embolism (PE) or deep vein thrombosis (DVT) symptoms with new thrombus or exacerbation of thrombus, and major bleeding was defined according to the International Society of Thrombosis and Hemostasis (ISTH) guidelines.

The patients were aged younger than 65 years (36.7%), 65 to 80 years (43.4%), or older than 80 years (19.9%). The 3 age groups comprised 55%, 62%, and 73% women (P <.001); they had a mean BMI of 24.0, 23.0, and 22.0 (P <.001); 21%, 44%, and 58% had hypertension (P <.001); and 60%, 56%, and 52% had PE with or without DVT (P =.003), respectively.

During treatment, younger patients were more likely to receive thrombolysis (P <.001), inferior vena cava filter (P =.004), and anticoagulation therapy beyond the acute phase (P =.04) compared with older patients. The youngest cohort were also more likely to discontinue anticoagulation during follow-up compared with the older cohorts (P <.001), primarily due to physician’s judgment.

At 5 years, recurrence occurred among 12.7%, 9.8%, and 7.4%; major bleeding occurred among 10.8%, 12.2%, and 14.9%; and all-cause mortality among 23.0%, 31.4%, and 38.6% of the patients aged younger than 65 years, 65 to 80 years, and older than 80 years, respectively. The cumulative incidence over time of VTE recurrence (P =.008) and mortality (P <.001), but not major bleeding (P =.37), depended on age.

Compared with the youngest group, those who were aged 65 to 80 years were at lower risk for VTE recurrence (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.53-0.94; P =.02) but had higher risk for mortality (aHR, 1.20; 95% CI, 1.01-1.42; P =.03). Similarly, the patients aged older than 80 years were at lower risk for VTE recurrence (aHR, 0.59; 95% CI, 0.39-0.89; P =.01) and increased risk for mortality (aHR, 2.20; 95% CI, 1.79-2.71; P <.001) compared with the youngest cohort.

These findings may have been biased, as this is an observational study and physician’s treatment decisions, such as discontinuing anticoagulation therapy, may have influenced outcomes.

The study authors wrote, “In the current real-world VTE registry, there was no significant difference in the risk of major bleeding depending on different age groups, while younger patients showed an excess risk for recurrent VTE compared with older patients.”

Disclosures: This research was supported by Mitsubishi Tanabe Pharma Corporation. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.