Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study

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

doi:10.1055/s-0042-1748889

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2022; 122(10): 1744-1756
DOI: 10.1055/s-0042-1748889

Stroke, Systemic or Venous Thromboembolism

Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study

Steve Raoul Noumegni

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Vincent Mansourati

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

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

,

Cécile Tromeur

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Raphael Le Mao

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Clément Hoffmann

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Emmanuelle Le Moigne

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Bahaa Nasr

⁴Department of Vascular Surgery, Brest Teaching Hospital, Brest, France

,

Jean-Christophe Gentric

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

⁵Department of Neuroradiology, Brest Teaching Hospital, Brest, France

,

Marie Guegan

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Elise Poulhazan

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Luc Bressollette

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Karine Lacut

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Francis Couturaud

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

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

,

Romain Didier

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

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

› Institutsangaben

Abstract

Background Cardiovascular deaths (CVDTs) are more frequent in patients with venous thromboembolism (VTE) than in the general population; however, risk factors associated with this increased risk of CVDT in patients with VTE are not described.

Methods To determine the risk factors of CVDT in patients with VTE from a multicenter prospective cohort study, Fine and Gray subdistribution hazard models were conducted.

Results Of the 3,988 included patients, 426 (10.7%) died of CVDT during a median follow-up of 5 years. The risk factors of CVDT after multivariate analyses were: age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 3.22, 95% confidence interval [CI]: 1.67–6.62), age >65 years (vs. <50 years, HR: 7.60, 95% CI: 3.73–15.52), cancer-associated VTE (vs. transient risk factor-related VTE, HR: 1.73, 95% CI: 1.15–2.61), unprovoked VTE (vs. transient risk factor-related VTE, HR: 1.42, 95% CI: 1.02–2.00), past tobacco use (vs. never, HR: 1.43, 95% CI: 1.06–1.94), current tobacco use (vs. never, HR: 1.87, 95% CI: 1.15–3.01), hypertension (HR: 2.11, 95% CI: 1.51–2.96), chronic heart failure (HR: 2.28, 95% CI: 1.37–3.79), chronic respiratory failure (HR: 1.72, 95% CI: 1.02–2.89), and atrial fibrillation (HR: 1.67, 95% CI: 1.06–2.60). The risk of CVDT was significantly reduced with direct oral anticoagulants (vs. vitamin-K antagonists) and with longer duration of treatment (>3 months).

Conclusion Risk factors of CVDT after VTE include some traditional cardiovascular risk factors and other risk factors that are related to characteristics of VTE, and patients' comorbidities.

Keywords

venous thromboembolism - cardiovascular deaths - cardiovascular mortality - risk factors - predictor - prospective cohort

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Referenzen

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