Iva Golemi1, Lauren Cote2, Omer Iftikhar3, Benjamin Brenner4, Alfonso Tafur5, Behnood Bikdeli6, Carmen Fernández-Capitán7, José María Pedrajas8, Remedios Otero9, Roberto Quintavalla10, Manuel Monreal11. 1. Department of Medicine, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill. Electronic address: igolemi@northshore.org. 2. Department of Nursing/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill. 3. Division of Cardiology, Department of Medicine, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill. 4. Haematology Department, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. 5. Department of Medicine and Vascular Medicine, Evanston NorthShore University HealthSystem, Evanston, Ill. 6. Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Cardiology, Cardiovascular Research Foundation, New York, NY. 7. Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain. 8. Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain. 9. Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocio, Seville, Spain. 10. Department of Medicine, Azienda Ospedaliera Universitaria, Parma, Italy. 11. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Internal Medicine, Universidad Católica de Murcia, Murcia, Spain.
Abstract
OBJECTIVE: Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE. METHODS: We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of <.05 was considered statistically significant. RESULTS: We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE. CONCLUSIONS: Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.
OBJECTIVE: Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE. METHODS: We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of <.05 was considered statistically significant. RESULTS: We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE. CONCLUSIONS: Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.
Authors: Anthony Maraveyas; Jan Beyer-Westendorf; Agnes Y Lee; Lorenzo G Mantovani; Yoriko De Sanctis; Khaled Abdelgawwad; Samuel Fatoba; Miriam Bach; Alexander T Cohen Journal: Res Pract Thromb Haemost Date: 2021-11-30