Anticoagulation: patients over 72 years old were at increased risk of bleeding on heparin.

Clinical bottom line (level 1b)

  1. A tenth of patients with proximal deep vein thrombosis who were given heparin had a bleed within 10 days. A twentieth will had a major bleed.
  2. Patients with proximal deep vein thrombosis who were on intravenous heparin were at increased risk of bleeding if they are over 72 years old (NNF = 15 for 10 days) .
Campbell et al: Archives of Internal Medicine 1996; 156: 857-860
Expires June 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Canada

198 patients (aged range 20 to 93 years; mean 67, 53% female) proximal deep vein thrombosis diagnosed by venogram

Excluded if
  • active bleeding disorder
  • heparin iv given already for >24 hours
  • unable to be followed up



    • Factors studied:
  • any bleed, major bleed
  • aged >72
  • aged >72


    • heparin 5000 units bolus iv, then 40,000 units/24 hours if 'low risk' for bleeding, or 30,000 units if 'high risk'. Heparin received for five days. aPTT monitored. Warfarin- therapeutic range INR 2.0-3.0; heparin continued until INR = 2.0

    Multiple regression analysis was performed to adjust for bleeding risk, gender, weight and dosing regimen.

    ?100% followed for 10 days
    Outcomes studied:
  • any bleed
  • major bleed two units transfused or retroperitoneal, intracranial or at major prosthetic joint

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    any bleed 10 days 21/198 10.6%
    (6.32% to 14.9%)
    major bleed 10 days 13/198 6.57%
    (3.12% to 10.0%)

    prognostic factor for
    any bleed     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    aged >72 10 days 1.61
    (1.03 to 2.53)     		15
    (6 to 300)

    prognostic factor for
    major bleed     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    aged >72 10 days 1.38
    (1.00 to 1.91)     		40
    (17 to inf)

    Comments

    1. Needs to be confirmed in a test set of patients.

    Citation

    1. Campbell NR, Hull RD, Brant R, et al: Aging and heparin-related bleeding. Archives of Internal Medicine 1996; 156: 857-860
    Search Terms: anticoag* in Cochrane
    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer: Daniel Sontheimer

    Clinical Question.
    Patient proximal DVT
    Intervention or Exposure age and heparin
    Outcome any bleed