The influence of anemia on clinical outcomes in venous thromboembolism: Results from GARFIELD-VTE

Abstract

Clinical characteristics and outcomes of venous thromboembolism (VTE) patients with concomitant anemia are unclear. This study compares baseline characteristics, treatment patterns, and 24-month outcomes in patients with and without anemia within GARFIELD-VTE. Materials and methods: GARFIELD-VTE (ClinicalTrials.gov: NCT02155491) is a global, prospective, noninterventional registry of real-world treatment practices. Of the 10,679 patients enrolled in GARFIELD-VTE, 7698 were eligible for analysis. Primary outcomes were all-cause mortality, recurrent VTE, and major bleeding in VTE patients with or without concomitant anemia over 24-months after diagnosis. Event rates and 95% confidence intervals were estimated using Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models. Results: Distribution of VTE events in 2771 patients with anemia and 4927 without anemia was similar (deepvein thrombosis alone: 61⋅1% vs. 55⋅9%, pulmonary embolism ± deep vein thrombosis: 38⋅9% vs. 44⋅0%, respectively). Patients with anemia were older (62.6 year vs. 58.9 years) than those without. At baseline, VTE risk factors that were more common in patients with anemia included hospitalization (22⋅0% vs. 6⋅8%), surgery (19⋅2% vs. 8⋅2%), cancer (20⋅1% vs. 5⋅6%) and acute medical illness (8⋅3% vs. 4⋅2%). Patients with anemia were more likely to receive parenteral anticoagulation therapy alone than those without anemia (26⋅6% vs. 11⋅7%) and less likely to receive a direct oral anticoagulant (38⋅5% vs. 53⋅5%). During 24-months of follow-up, patients with anemia had a higher risk (adjusted hazard ratio [95% confidence interval]) of all-cause mortality (1⋅84 [1⋅56-2⋅18]), major bleeding (2⋅83 [2⋅14-3⋅75]). Among anemia patients, the risk of all-cause mortality and major bleeding remained higher in patients with severe anemia than in those with mild/moderate anemia, allcause mortality: HR 1⋅43 [95% CI: 1⋅21-1⋅77]; major bleeding: HR 2⋅08 [95% CI: 1⋅52-2⋅86]).

Safety and Efficacy of Rivaroxaban for Extended-Phase Anticoagulation of Patients with Unprovoked or Recurrent Venous Thromboembolism: Real-Life Data from the MAC Project

“…Such findings confirm what was recently reported by a meta-analysis of all trials investigating direct anticoagulant use for VTE treatment [ 19 ], although the follow-up in the latter was limited to 12 months. They are also in line with observations from the RIETE Registry, although in patients treated only with VKA [ 15 , 20 , 21 , 22 , 23 ].…”

Identifying prognostic factors for pulmonary embolism patients with hemodynamic decompensation admitted to the intensive care unit

“…A large scale research with a real-world populations demonstrated that VTE patients (comprising 38.9% PE patients and 61.1% deep venous thromboembolism patients) with anemia faced a higher risk of all-cause mortality and major bleeding, and severe anemia was related with a larger risk of adverse outcomes. [15] Besides, the study with the multicentre registry in China also screened out that the anemia was one of risk factors associated with in-hospital all-cause mortality in hemodynamically stable PE patients (OR: 2.0, 95% CI: 1.3–3.0, P = .0020) though the multivariable analysis within hemodynamically unstable group excluded anemia as the independent factor. [9] Additionally, a prospective study developed an original risk score to predict early major bleeding in acute PE including anemia (defined as hemoglobin < 12 g/dL) as one of the 3 assessment items and the score proportion of anemia item was highest, which identified anemia as the most powerful prognostic factor of early major bleeding.…”

Antikoagulation bei Thrombose und Lungenembolie

“…Eine Reihe von Studien konnte herausarbeiten, dass Anämie ein wichtiger Prädiktor für das Auftreten von Blutungen ist. In GAR-FIELD-VTE [13], einem Real-World-Register, wurde der Einfluss von Anämie auf Blutungsrisiko und klinischen Verlauf analysiert. Es zeigt sich, dass Patienten mit Anämie ein 2,8-fach höheres Risiko für schwere Blutungen aufweisen; am häufigsten waren gastrointestinale Blutungen.…”