PURPOSE: Baseline characteristics, clinical presentation, and management differences in elderly patients with deep vein thrombosis (DVT) have not been well defined.
METHODS: We compared 1,932 DVT patients aged 70 years or older with 2,554 nonelderly patients in a prospective registry of 5,451 consecutive ultrasound-confirmed DVT patients at 183 institutions in the United States. We excluded 965 patients with uncertain age.
RESULTS: Elderly patients had a mean age of 78.9±6.1 years compared with a mean age of 51.8±12.9 years in the nonelderly. The elderly had a lower mean body mass index (26.7±6 kg/m2 versus 29.7±8 kg/m2, p<0.0001) and were more often inpatients at the time of diagnosis (55.6% versus 48.1%, p<0.0001). Elderly patients were more likely to have prior hospitalization (49.2% versus 44.7%, p=0.03), congestive heart failure (20.5% versus 9.9%, p<0.0001), chronic obstructive pulmonary disease (18.2% versus 11.7%, p<0.0001), and recent immobilization (50.5% versus 39.6%, p<0.0001) than nonelderly patients with DVT. Elderly patients were less likely to present with typical DVT symptoms of extremity discomfort (44.4% versus 60.6%, p<0.0001) and difficulty ambulating (8.4% versus 11.2%, p=0.002). Although more likely to have received prophylactic measures within 30 days prior to DVT diagnosis than nonelderly patients (41% versus 34.5%, p<0.0001), less than one-half of elderly patients who were subsequently diagnosed with DVT had received venous thromboembolism (VTE) prophylaxis. Elderly patients with DVT were less likely to be treated as outpatients (16.3% versus 21.2%, p=0.005) and were more likely to receive inferior vena cava (IVC) filters (17.9% versus 12.5%, p<0.0001).
CONCLUSION: Elderly patients with DVT represent a particularly vulnerable population. Diagnosis is more challenging because their presentations are more often atypical. Fewer than half of elderly patients received VTE prophylaxis. In addition, the elderly required hospitalization and underwent insertion of IVC filters more often than nonelderly patients.
CLINICAL IMPLICATIONS: Further studies are required to elucidate why prophylaxis is frequently omitted in the elderly and to determine how utilization can be improved.
DISCLOSURE: Gregory Piazza, No Product/Research Disclosure Information; Grant monies (from industry related sources) This study was supported, in part, by an unrestricted research grant from Sanofi-Aventis; Consultant fee, speaker bureau, advisory committee, etc. Dr. Samuel Z. Goldhaber has served as a consultant for Sanofi-Aventis.