Background: Despite the rise of direct oral anti-coagulants, vitamin K antagonists (VKA) still dominate clinician prescriptions in venous thromboembolic disease (VTED), mainly in low- and middle-income countries. Maintaining INR within the therapeutic range is a real challenge especially for elderly patients who are often polymedicated and non-autonomous. The lower risk efficacy of VKA treatment appears to be favorable when the time spent in the therapeutic range (TTR) is ≥ 65%.

Aims: The aim of this study was to evaluate the stability of the INR of patients over 65 years old followed for VTED through the TTR.

Methods: This was a prospective, longitudinal and descriptive study involving patients over 65 years old, admitted for VTED treated by VKA in the internal medicine department between January 2015 and December 2017. The TTR was calculated by the Rosendaal method.

Results: Twenty-two patients were included. The average age was 75 years old [65-96]. The gender ratio was 0.69 with 13 (59%) men and 9 (41%) women. Twenty-one (96%) patients had deep vein thrombosis and one patient (4%) had pulmonary embolism. The mean TTR of the studied population was 40.5% [2.2%-77,6%]. Four (18%) cases of hemorrhagic complications and 4 (18%) cases of thrombotic complications were noted with mean TTRs of 19.5% and 41,5%, respectively. At the control imaging, 36% (8 patients) of the total cases had totally recanalized and 64% (14 patients) had partially recanalized with mean TTRs respectively of 33,8% and 44,3%.

Conclusions: TTR is a pertinent therapeutic safety factor that could be a marker of cognitive decline in the elderly population.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/time-in-therapeutic-range-in-venous-thromboembolic-diseases-in-a-north-african-geriatric-population/