Document Detail


Pulmonary embolism in patients over 90 years of age.
MedLine Citation:
PMID:  20671514     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: There is some uncertainty about the management of pulmonary embolism in nonagenarians.
RECENT FINDINGS: Immobility plays an important role in the pathogenesis of venous thromboembolism in the elderly. Of 858 nonagenarians with acute venous thromboembolism enrolled in Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, 41% had recent immobility and only 7.7% had recent surgery. Comorbidity is common: 19% of patients had chronic heart failure, 9.8% chronic lung disease, 14% cancer, and 63% had abnormal creatinine levels. Most (92%) of the patients were initially treated with low-molecular-weight heparin and then 46% switched to antivitamin K drugs. During follow-up, the proportion of patients who developed recurrent venous thromboembolism (4.9%) or major bleeding complications (6.2%) was similar, but the 5.9% of fatal pulmonary embolisms by far exceeded the 2.2% of fatal bleeding events. The most common clinical symptoms are isolated dyspnea and syncope, and presentation as pulmonary infarction (with hemoptysis and pleuritic chest pain) is rare.
SUMMARY: In patients aged at least 90 years presenting with acute pulmonary embolism, the incidence of fatal pulmonary embolism by far outweighs the incidence of fatal bleeding, and pulmonary embolism is the most common cause of death. Thus, there seems to be more reason to be concerned about fatal pulmonary embolism than about bleeding in elderly patients presenting with pulmonary embolism.
Authors:
Manuel Monreal; Luciano López-Jiménez
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in pulmonary medicine     Volume:  16     ISSN:  1531-6971     ISO Abbreviation:  Curr Opin Pulm Med     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503765     Medline TA:  Curr Opin Pulm Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  432-6     Citation Subset:  IM    
Affiliation:
Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. mmonreal.germanstrias@gencat.cat
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MeSH Terms
Descriptor/Qualifier:
4-Hydroxycoumarins / adverse effects,  therapeutic use
Age Factors
Aged, 80 and over
Anticoagulants / adverse effects,  therapeutic use
Female
Hemorrhage / epidemiology
Heparin, Low-Molecular-Weight / adverse effects,  therapeutic use*
Humans
Incidence
Indenes / adverse effects,  therapeutic use
Male
Pulmonary Embolism / drug therapy*,  epidemiology*
Risk Factors
Spain
Vitamin K / adverse effects,  antagonists & inhibitors,  therapeutic use
Chemical
Reg. No./Substance:
0/4-Hydroxycoumarins; 0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 0/Indenes; 0/antivitamins K; 12001-79-5/Vitamin K

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