Fragile patients with venous thromboembolism. What did we learn from RIETE.

Abstract

In recent years, a number of new anticoagulants have been developed for the treatment of venous thromboembolism (VTE), demonstrating significant reductions in major bleeding compared with standard therapy. Subgroup analyses showed favourable results for rivaroxaban in the so-called fragile patients (defined as those having creatinine clearance levels ≤50 mL/min, age ≥75 years or body weight ≤50 kg) compared with standard therapy. However, the prevalence of fragile patients with VTE in real life and their natural history during the course of anticoagulation has not been thoroughly investigated. We used the RIETE registry database to assess the proportion of fragile patients with VTE in real life, and their natural history during the course of anticoagulant therapy. We found that 43% of patients with VTE were fragile, and that they had an over 2-fold higher rate of major bleeding during the course of anticoagulant therapy compared with non-fragile patients.