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Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study

In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE), similar to 12-13% of patients were elderly and similar to 26% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treat...

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Main Authors:	Ageno, Walter, Casella, Ivan B., Chee, Kok Han, Schellong, Sebastian, Schulman, Sam, Singer, Daniel E., Desch, Marc, Tang, Wenbo, Voccia, Isabelle, Zint, Kristina, Goldhaber, Samuel Z.
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Published:	Springer 2021
Subjects:	R Medicine (General)
Online Access:	http://eprints.um.edu.my/34413/
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spelling	my.um.eprints.344132022-09-13T08:01:31Z http://eprints.um.edu.my/34413/ Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study Ageno, Walter Casella, Ivan B. Chee, Kok Han Schellong, Sebastian Schulman, Sam Singer, Daniel E. Desch, Marc Tang, Wenbo Voccia, Isabelle Zint, Kristina Goldhaber, Samuel Z. R Medicine (General) In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE), similar to 12-13% of patients were elderly and similar to 26% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treatment criteria of RCTs. In this ancillary analysis of the RE-COVERY DVT/PE global observational study, we aimed to describe patient characteristics, comorbidities, and anticoagulant therapy for subgroups of age (< or >= 75 years) and renal impairment (creatinine clearance CrCl; estimated with Cockcroft-Gault formula] < 30 severe], 30 to < 50 moderate], 50 to < 80 mild], >= 80 normal] mL/min). Of 6095 eligible patients, 25.3% were aged >= 75 years; 38.2% (1605/4203 with CrCl values) had mild-to-moderate renal impairment. Comorbidities were more common in older patients (73.9% aged >= 75 vs. 58.1% < 75 years) and in those with mild or moderate versus no renal impairment (75.9%, 80.9%, and 59.3%, respectively). At hospital discharge or 14 days after diagnosis (whichever was later), most patients (53.7% and 55.1%, respectively) in both age groups received NOACs; 20.8% and 23.4%, respectively, received vitamin K antagonists, 19.0% and 21.8% parenteral therapy, 2.3% and 3.8% other anticoagulant treatments. Use of NOACs decreased with worsening renal impairment (none 58.5%, moderate 49.6%, severe 25.7%) and, in younger versus older patients with moderate renal impairment (33.1% vs. 56.1%). In routine practice, there are more elderly and renally impaired patients with VTE than represented in RCTs. Decreasing renal function, but not older age, was associated with less NOAC use. Clinical Trial Registration:. Unique identifier: NCT02596230. Graphic abstract Decreasing renal function, particularly in the subgroup with CrCl < 30 mL/min, but not older age, was associated with less use of nonvitamin K antagonist oral anticoagulants (NOACs). Nevertheless, more than half of the older patients with moderate renal impairment received a NOAC as their oral anticoagulant. Springer 2021-04 Article PeerReviewed Ageno, Walter and Casella, Ivan B. and Chee, Kok Han and Schellong, Sebastian and Schulman, Sam and Singer, Daniel E. and Desch, Marc and Tang, Wenbo and Voccia, Isabelle and Zint, Kristina and Goldhaber, Samuel Z. (2021) Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study. Journal of Thrombosis And Thrombolysis, 51 (3). pp. 561-570. ISSN 0929-5305, DOI https://doi.org/10.1007/s11239-020-02239-9 <https://doi.org/10.1007/s11239-020-02239-9>. 10.1007/s11239-020-02239-9
institution	Universiti Malaya
building	UM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Malaya
content_source	UM Research Repository
url_provider	http://eprints.um.edu.my/
topic	R Medicine (General)
spellingShingle	R Medicine (General) Ageno, Walter Casella, Ivan B. Chee, Kok Han Schellong, Sebastian Schulman, Sam Singer, Daniel E. Desch, Marc Tang, Wenbo Voccia, Isabelle Zint, Kristina Goldhaber, Samuel Z. Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
description	In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE), similar to 12-13% of patients were elderly and similar to 26% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treatment criteria of RCTs. In this ancillary analysis of the RE-COVERY DVT/PE global observational study, we aimed to describe patient characteristics, comorbidities, and anticoagulant therapy for subgroups of age (< or >= 75 years) and renal impairment (creatinine clearance CrCl; estimated with Cockcroft-Gault formula] < 30 severe], 30 to < 50 moderate], 50 to < 80 mild], >= 80 normal] mL/min). Of 6095 eligible patients, 25.3% were aged >= 75 years; 38.2% (1605/4203 with CrCl values) had mild-to-moderate renal impairment. Comorbidities were more common in older patients (73.9% aged >= 75 vs. 58.1% < 75 years) and in those with mild or moderate versus no renal impairment (75.9%, 80.9%, and 59.3%, respectively). At hospital discharge or 14 days after diagnosis (whichever was later), most patients (53.7% and 55.1%, respectively) in both age groups received NOACs; 20.8% and 23.4%, respectively, received vitamin K antagonists, 19.0% and 21.8% parenteral therapy, 2.3% and 3.8% other anticoagulant treatments. Use of NOACs decreased with worsening renal impairment (none 58.5%, moderate 49.6%, severe 25.7%) and, in younger versus older patients with moderate renal impairment (33.1% vs. 56.1%). In routine practice, there are more elderly and renally impaired patients with VTE than represented in RCTs. Decreasing renal function, but not older age, was associated with less NOAC use. Clinical Trial Registration:. Unique identifier: NCT02596230. Graphic abstract Decreasing renal function, particularly in the subgroup with CrCl < 30 mL/min, but not older age, was associated with less use of nonvitamin K antagonist oral anticoagulants (NOACs). Nevertheless, more than half of the older patients with moderate renal impairment received a NOAC as their oral anticoagulant.
format	Article
author	Ageno, Walter Casella, Ivan B. Chee, Kok Han Schellong, Sebastian Schulman, Sam Singer, Daniel E. Desch, Marc Tang, Wenbo Voccia, Isabelle Zint, Kristina Goldhaber, Samuel Z.
author_facet	Ageno, Walter Casella, Ivan B. Chee, Kok Han Schellong, Sebastian Schulman, Sam Singer, Daniel E. Desch, Marc Tang, Wenbo Voccia, Isabelle Zint, Kristina Goldhaber, Samuel Z.
author_sort	Ageno, Walter
title	Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
title_short	Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
title_full	Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
title_fullStr	Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
title_full_unstemmed	Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
title_sort	profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: re-covery dvt/pe study
publisher	Springer
publishDate	2021
url	http://eprints.um.edu.my/34413/
_version_	1744649178554826752
score	13.211869

Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study

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