Risk Factors for Major Adverse Cardiovascular Events and Major Adverse Limb Events after Venous Thromboembolism: A Large Prospective Cohort Study

Steve Raoul Noumegni; Romain Didier; Vincent Mansourati; Emmanuelle Le Moigne; Raphael Le Mao; Clément Hoffmann; Claire De Moreuil; Cécile Tromeur; Pierre-Yves Le Roux; Bahaa Nasr; Jean-Christophe Gentric; Marie Guegan; Elise Poulhazan; Karine Lacut; Luc Bressollette; Francis Couturaud

doi:10.1055/s-0042-1748152

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2022; 48(04): 465-480
DOI: 10.1055/s-0042-1748152

Review Article

Risk Factors for Major Adverse Cardiovascular Events and Major Adverse Limb Events after Venous Thromboembolism: A Large Prospective Cohort Study

Steve Raoul Noumegni

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Romain Didier

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

³Department of Cardiology, Brest Teaching Hospital, Brest, France

,

Vincent Mansourati

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

³Department of Cardiology, Brest Teaching Hospital, Brest, France

,

Emmanuelle Le Moigne

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Raphael Le Mao

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Clément Hoffmann

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Claire De Moreuil

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Cécile Tromeur

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Pierre-Yves Le Roux

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

⁴Department of Nuclear Medicine, Brest Teaching Hospital, Brest, France

,

Bahaa Nasr

⁵Department of Vascular Surgery, Brest Teaching Hospital, Brest, France

,

Jean-Christophe Gentric

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

⁶Department of Neuroradiology, Brest Teaching Hospital, Brest, France

,

Marie Guegan

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Elise Poulhazan

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Karine Lacut

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Luc Bressollette

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Francis Couturaud

¹Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France

²Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

› Author Affiliations

Abstract

Background There is an increased risk of arterial events including major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after venous thromboembolism (VTE). However, their risk factors remain little explored.

Methods We aimed to determine the risk factors for MACE (acute coronary syndrome/stroke/cardiovascular death) and MALE (limb ischemia/critical limb ischemia/non-traumatic amputation/any limb revascularization) after VTE. Competing risk models (Fine-Gray) were used in a multicenter prospective cohort of 4,940 patients (mean age: 64.6 years and median follow-up: 64 months).

Results MACE occurred in 17.3% of participants (2.35% per patient-years) and MALE in 1.7% (0.27% per patient-years). In multivariable analysis, the identified risk factors for MACE were the age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.38–2.91), age >65 years (vs. <50 years, HR 4.85, 95% CI: 3.35–7.02), pulmonary embolism + deep vein thrombosis (DVT) (vs. isolated-DVT, HR: 1.25, 95% CI: 1.02–1.55), unprovoked-VTE (vs. transient risk factor associated-VTE, HR: 1.29, 95% CI: 1.04–1.59), current tobacco use (vs. never, HR: 1.45, 95% CI: 1.07–1.98), hypertension (HR: 1.61, 95% CI: 1.30–1.98), past history of symptomatic atherosclerosis (HR: 1.52, 95% CI: 1.17–1.98), heart failure (HR: 1.71, 95% CI: 1.21–2.42), atrial fibrillation (HR: 1.55, 95% CI: 1.15–2.08), and vena cava filter insertion (HR: 1.46, 95% CI: 1.03–2.08). The identified risk factors for MALE were the age of 50–65 years (vs. <50 years, HR: 3.49, 95% CI: 1.26–9.65) and atrial fibrillation (HR: 2.37, 95% CI: 1.15–4.89).

Conclusions Risk factors for MACE and MALE after VTE included some traditional cardiovascular risk factors, patient's comorbidities, and some characteristics of VTE.

Keywords

venous thromboembolism - arterial cardiovascular event - MACE - MALE - prospective cohort

Full Text

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Supplementary Material

Supplementary Material