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.
|Journal||Journal of Vascular Surgery: Venous and Lymphatic Disorders|
|State||Published - May 2020|
Bibliographical noteFunding Information:
We express our gratitude to Sanofi Spain for supporting the RIETE Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting the RIETE Registry. Bayer Pharma AG's support was limited to the part of RIETE outside of Spain, which accounts for 25.10% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data and logistic and administrative support.
Conception and design: IG, AT, MM Analysis and interpretation: IG, AT, MM Data collection: IG, LC, OI, BenB, AT, BehB, CF, JP, RO, RQ, MM Writing the article: IG, AT, MM Critical revision of the article: IG, LC, OI, BenB, AT, BehB, CF, JP, RO, RQ, MM Final approval of the article: IG, LC, OI, BenB, AT, BehB, CF, JP, RO, RQ, MM Statistical analysis: Not applicable Obtained funding: Not applicable Overall responsibility: IG IG and AT contributed equally to this article and share co-first authorship. We express our gratitude to Sanofi Spain for supporting the RIETE Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting the RIETE Registry. Bayer Pharma AG's support was limited to the part of RIETE outside of Spain, which accounts for 25.10% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data and logistic and administrative support. Appendix (online only) Coordinator of the RIETE Registry: Dr Manuel Monreal (Spain); RIETE Steering Committee Members: Dr Paolo Prandoni (Italy), Dr Benjamin Brenner (Israel), and Dr Dominique Farge-Bancel (France); RIETE National Coordinators: Dr Raquel Barba (Spain), Dr Pierpaolo Di Micco (Italy), Dr Laurent Bertoletti (France), Dr Inna Tzoran (Israel), Dr Abilio Reis (Portugal), Dr Henri Bounameaux (Switzerland), Dr Radovan Malý (Czech Republic), Dr Peter Verhamme (Belgium), Dr Marijan Bosevski (Republic of Macedonia), Dr Joseph A. Caprini (United States), Dr Hanh My Bui (Vietnam); RIETE Registry Coordinating Center: S&H Medical Science Service; Members of the RIETE Group: Spain—Adarraga MD, Aibar MA, Aibar J, Amado C, Arcelus JI, Azcarate PM, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Camon AM, Carrasco C, Castro J, de Ancos C, del Toro J, Demelo P, Díaz-Pedroche MC, Díaz-Peromingo JA, Díaz-Simón R, Encabo M, Falgá C, Farfán AI, Fernández-Capitán C, Fernández-Criado MC, Fidalgo MA, Font C, Font L, García MA, García-Bragado F, García-Morillo M, García-Raso A, Gavín O, Gaya I, Gayol MC, Gil-Díaz A, Guirado L, Gómez V, González-Martínez J, Grau E, Gutiérrez J, Hernández Blasco LM, Iglesias M, Jara-Palomares L, Jaras MJ, Jiménez D, Jou I, Joya MD, Lalueza A, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Miguel P, López-Nuñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Marchena PJ, Martín-Guerra JM, Martín Fernández M, Mellado M, Monreal M, Morales MV, Nieto JA, Núñez MJ, Olivares MC, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez-Pinar M, Pérez-Rus G, Peris ML, Pesce ML, Porras JA, Rivas A, Rodríguez-Dávila MA, Rodríguez-Fernández L, Rodríguez-Hernández A, Rodríguez-Martín C, Rubio CM, Ruiz-Alcaraz S, Ruiz-Artacho P, Ruiz-Ruiz J, Ruiz-Sada P, Sahuquillo JC, Salazar V, Sampériz A, Sánchez-Muñoz-Torrero JF, Sancho T, Sanoja I, Soler S, Soto MJ, Suriñach JM, Tolosa C, Torres MI, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, and Vidal G; Argentina—Gutiérrez P, Vázquez FJ, and Vilaseca A; Belgium—Vanassche T, Vandenbriele C, and Verhamme P; Czech Republic—Hirmerova J and Malý R; Ecuador—Salgado E; France—Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Falvo N, Farge-Bancel D, Hij A, Mahé I, and Moustafa F; Israel: Braester A, Brenner B, Ellis M, and Tzoran I; Italy—Barillari G, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Dentali F, Di Micco P, Grandone E, Imbalzano E, Lessiani G, Maida R, Mastroiacovo D, Mumoli N, Vo Hong N, Pace F, Parisi R, Pesavento R, Pinelli M, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, and Visonà A; Latvia—Skride A, Sablinskis K, and Sablinskis M; Republic of Macedonia—Bosevski M and Zdraveska M; Switzerland—Bounameaux H, Fresa M, Ney B, and Mazzolai L; United States—Caprini J, and Tafur A; Vietnam—Bui HM. Appendix Additional material for this article may be found online at www.jvsvenous.org .
© 2019 Society for Vascular Surgery
- Major adverse cardiovascular events
- Major adverse limb events
- Venous thromboembolism