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

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.

Incidence and Risk Factors for Pregnancy-Associated Venous Thromboembolism: Are There Differences between East and West?

“…1 Even in this journal there has been much interest in the epidemiology, prognosis, and risk factors for VTE, as well as the pathophysiological mechanisms underlying the propensity to develop this common condition. 2 3 4 5 6 7…”

“…1 Even in this journal there has been much interest in the epidemiology, prognosis, and risk factors for VTE, as well as the pathophysiological mechanisms underlying the propensity to develop this common condition. [2][3][4][5][6][7] Pregnancy is an important risk factor for VTE. Several previous studies reported the incidence of pregnancy-associated VTE (PA-VTE) for Western population.…”

Residual Thrombosis: Still Relevant in the Direct Oral Anticoagulant (DOAC) Era?

“…[2][3][4] Indeed, potential risk factors for recurrence of venous thromboembolism have been investigated, 5,6 and some conditions may be predisposing to the high long-term risk of cardiovascular events in this population. 7 Anticoagulant treatment is effective in reducing recurrent venous thromboembolism by over 90%, but it is associated with the risk for life-threatening and even fatal bleeding complications. 8 Indeed, the perceived risk of bleeding limits every-day life activities in a substantial proportion of patients during anticoagulant treatment.…”

“…2 3 4 Indeed, potential risk factors for recurrence of venous thromboembolism have been investigated, 5 6 and some conditions may be predisposing to the high long-term risk of cardiovascular events in this population. 7…”

The Legacy of Edwards and Steptoe and the Windy Roads of Assisted Reproduction: Where Do We Stand with Venous Thromboembolism?

“…As in other fields of research on VTE, it should be interesting to combine clinical items (including family history), genetic factors, and biomarkers to try to outline the profile of patients at particularly high risk of incident VTE and VTE-related complications, given the intense interest into this area of risk profiling. [12][13][14][15][16][17][18][19][20][21] Hence, these could be applied to each woman approaching ART and validate scores that can be helpful in identifying those individuals at higher risk.…”