Management and Outcomes of Pulmonary Embolism in the Oldest-Old

Abstract

Eishan Beotra,1 Vincent JJ Ngian,1– 3 Fiona Tran,1– 3 Kelvin Hsu,1,4 Fintan O’Rourke,1,3 Bin S Ong1– 3 1South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; 2Department of Ambulatory Medicine and Medical Assessment Unit, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia; 3Department of Aged Care, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia; 4Department of Respiratory Medicine, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, NSW, AustraliaCorrespondence: Bin S Ong, Department of Ambulatory Care, Eldridge Road, Bankstown, NSW, 2200, Australia, Email [email protected]: Treatment for pulmonary embolism has expanded to include Direct Oral Anticoagulants (DOACs). The incidence of pulmonary-embolism (PE) in “oldest-old” age group (≥ 85 years) is rapidly increasing, but there is limited research on its management and clinical outcomes.Aim: To examine the differences in management and outcomes in those aged ≥ 85 years compared to other age groups.Methods: We performed a retrospective cohort-study of 373 consecutive patients with pulmonary embolism confirmed on imaging by Computed Tomography Pulmonary Angiogram (CTPA) or Ventilation Perfusion (VQ) Scan at a principal referral hospital in Sydney, Australia. Data collected include clinical and demographic data, Charlson comorbidity index, treatment type and outcomes including complications, recurrent venous thromboembolism, and mortality.Results: Across the age groups, DOACS were prescribed to 53.4% (n=199) of patients. In oldest-old patients with PE, LMWH bridging to warfarin was the most frequently prescribed treatment, used in 46.2% (n=18, 95% CI: 30.8%– 61.5%, p=0.003) of these patients. The mortality rate for patients on LMWH was 13.9% (n=5, 95% CI: 4.2%– 37.5%, p=0.553). Overall, major bleeding incidents were rare, occurring in just 1.7% (n=4, 95% CI: 0.4%– 3.3%) of patients, with no significant differences in outcomes across age groups.Conclusion: DOACs are increasingly used as the treatment modality of choice in atrial fibrillation but are less well studied in pulmonary embolism, particularly in oldest-old patients. We found that the safety and efficacy profile of DOACs in pulmonary embolism treatment is similar across the age groups. Our study does not support any change in treatment protocols of PE in the oldest old, but further studies are required to confirm our findings.Keywords: oldest-old, pulmonary embolism, anticoagulation, treatment, adverse outcomes

Keywords

• oldest-old
• pulmonary embolism
• anticoagulation
• treatment
• adverse outcomes