This registry analysis examined 5,763 patients with acute venous thromboembolism and creatinine clearance below 30 mL/min enrolled during 2005–2024. Mean age was 81 years, 69% were women, and 56% presented with pulmonary embolism. At 90 days, recurrent venous thromboembolism occurred in 1.3%, major bleeding in 5.1%, and death in 20%. Fatal pulmonary embolism exceeded fatal bleeding during days 0–10 (2.0% versus 0.3%), while fatal bleeding exceeded fatal pulmonary embolism during days 11–90 (0.7% versus 0.3%), describing a changing pattern of fatal events over follow-up.
This registry highlights high short-term mortality and differing timing of fatal pulmonary embolism and bleeding in severe renal insufficiency. It does not establish which anticoagulant strategy offers better outcomes.
Study limitation: The observational cohort combines pulmonary embolism and other venous thromboembolism; reported outcomes are not restricted to critically ill patients.
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