Key result
Elderly DVT patients present with typical extremity discomfort ~27% less often than nonelderly patients.
Why the study?
How do clinical presentation and comorbidities differ between elderly and nonelderly patients with deep-vein thrombosis?
Cohort (n=4,486)
How do clinical presentation and comorbidities differ between elderly and nonelderly patients with deep-vein thrombosis?
Absolute Event Rate: 44.4% vs 60.6%
p-value: p=<.0001
Elderly patients with DVT often present atypically without extremity discomfort and have higher rates of comorbidities, yet fewer than half receive appropriate VTE prophylaxis.
Elderly DVT patients may present atypically, warranting broader diagnostic suspicion; this Level 3 cohort finding leaves open the need for age-specific validation studies.
Venous thromboembolism, including deep-vein thrombosis and pulmonary embolism, is a major source of morbidity and mortality among elderly patients. To improve our understanding of elderly patients with deep-vein thrombosis, we compared 1932 patients with deep-vein thrombosis aged 70 years or older with 2554 nonelderly patients in a prospective registry of consecutive ultrasound-confirmed deep-vein thrombosis patients. The mean age of elderly patients was 78.9 +/- 6.1 years compared with 51.8 +/- 12.9 years in nonelderly (P < .0001). Elderly patients were more likely to have prior recent hospitalization (49.2% vs 44.7%, P = .03), congestive heart failure (20.5% vs 9.9%, P < .0001), chronic obstructive pulmonary disease (18.2% vs 11.7%, P < .0001), and recent immobilization (50.5% vs 39.6%, P < .0001) than the nonelderly patients. Elderly patients were less likely to present with typical deep-vein thrombosis symptoms of extremity discomfort (44.4% vs 60.6%, P < .0001) and difficulty ambulating (8.4% vs 11.2%, P = .002). Only 41% of elderly patients subsequently diagnosed with deep-vein thrombosis had received any venous thromboembolism prophylaxis. In conclusion, elderly patients with deep-vein thrombosis represent a particularly vulnerable population with numerous comorbid conditions. Diagnosis can present a challenge because typical deep-vein thrombosis symptoms may be absent. Fewer than 50% of elderly patients with deep-vein thrombosis had received any venous thromboembolism prophylaxis.
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Piazza et al. (2007) conducted a cohort in Deep-vein thrombosis (n=4,486). Advanced age (≥70 years) vs. Nonelderly age (<70 years) was evaluated on Typical deep-vein thrombosis symptoms of extremity discomfort (p=<.0001). Elderly patients (≥70 years) with deep-vein thrombosis were less likely to present with typical symptoms of extremity discomfort than nonelderly patients (44.4% vs 60.6%, P<0.0001).
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