Educational Level, Anticoagulation Quality, and Clinical Outcomes in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study

• Published in: PloS one Vol. 11; no. 9; p. e0162108
• Main Authors: Hofmann, Eveline, Faller, Nicolas, Limacher, Andreas, Méan, Marie, Tritschler, Tobias, Rodondi, Nicolas, Aujesky, Drahomir
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.09.2016; Public Library of Science (PLoS)
• Subjects: Acute Disease; Aged; Aged, 80 and over; Alcohol; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Bleeding; Cardiac arrhythmia; Cardiology; Cohort analysis; Data collection; Drug therapy; Education; Educational attainment; Educational Status; Elderly patients; Female; Geriatrics; Heart; Hemorrhage - chemically induced; High schools; Hospitals; Humans; Hypertension; Incidence; Internal medicine; Kaplan-Meier Estimate; Male; Medical research; Medicine and Health Sciences; Middle Aged; Older people; Patient outcomes; Patients; People and Places; Polypharmacy; Preventive medicine; Prospective Studies; Quality of life; Recurrence; Social Sciences; Socioeconomic factors; Stroke; Studies; Thromboembolism; Thrombosis; Treatment Outcome; Venous Thromboembolism - drug therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0162108

Whether the level of education is associated with anticoagulation quality and clinical outcomes in patients with acute venous thromboembolism (VTE) is uncertain. We thus aimed to investigate the association between educational level and anticoagulation quality and clinical outcomes in elderly patients with acute VTE. We studied 817 patients aged ≥65 years with acute VTE from a Swiss prospective multicenter cohort study (09/2009-12/2013). We defined three educational levels: 1) less than high school, 2) high school, and 3) post-secondary degree. The primary outcome was the anticoagulation quality, expressed as the percentage of time spent in the therapeutic INR range (TTR). Secondary outcomes were the time to a first recurrent VTE and major bleeding. We adjusted for potential confounders and periods of anticoagulation. Overall, 56% of patients had less than high school, 25% a high school degree, and 18% a post-secondary degree. The mean percentage of TTR was similar across educational levels (less than high school, 61%; high school, 64%; and post-secondary, 63%; P = 0.36). Within three years of follow-up, patients with less than high school, high school, and a post-secondary degree had a cumulative incidence of recurrent VTE of 14.2%, 12.9%, and 16.4%, and a cumulative incidence of major bleeding of 13.3%, 15.1%, and 15.4%, respectively. After adjustment, educational level was neither associated with anticoagulation quality nor with recurrent VTE or major bleeding. In elderly patients with VTE, we did not find an association between educational level and anticoagulation quality or clinical outcomes.