HEMORRHAGIC COMPLICATIONS AND THROMBOTIC EVENTS WITH ORAL ANTICOAGULATION IN ELDERLY PATIENTS

Objective. To retrospectively analyze the hemorrhagic complications an d thrombotic events associated with aging and the degree of anticoagul ation in a series of ambulatory patients treated with acenocumarol and controlled in a specialized anticoagulant therapy unit. Patients and methods. A total of 1,613 ambulatory patients were studied. Patients w ere divided into two groups (group 1, 645 patients > 65 years old, mea n age 71.7 +/- 4.5 years; INR, 2.1-2.8; group 2, 968 patients less tha n or equal to 65 years, mean age 53.7 +/- 10 years; INR, 2.8-4.2) for a time period of twelve months. The prevalence of hemorrhagic complica tions and severity according to a validated international index (Bleed ing Severity Index), as well as the thrombotic events occurred despite anticoagulation therapy. Results. Fifty-two hemorrhagic events (8/100 patients-year) were recorded in the older group (group 1). Twenty-six cases were considered banal episodes, 24 minor hemorrhages and two ma jor hemorrhages. Ten patients (1.5/100 patients-year) had thrombotic c omplications. In the younger group (group 2) 150 bleeding episodes wer e recorded (15 patients-year), of which 11 were banal, 39 minor hemorr hages and no major hemorrhages. Only eight patients 0.8/100 patients-y ear) had thrombosis. The presence of local factors predisposing to ble eding was more common in group 1 (p < 0.001). Older patients had in ge neral more complications than younger patients (p < 0.001), but no sig nificant differences were observed between the occurrence of hemorrhag es or thrombosis independently analyzed between both groups. The rate in the therapeutic range was greater among the youngest individuals (p < 0.05). Conclusions. Our results support the idea that patients with advanced age can benefit from a less aggressive anticoagulation. A st atistical trend was observed, although not significant, towards the pr esence of major hemorrhages and thrombosis in this group of patients. The presence of local or predisposing factors to hemorrhage (underlyin g disease and NSAIDs use) is more relevant in patients with advanced a ge.