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Noumegni SR, Mansourati V, Tromeur C, Mao RL, Hoffmann C, Moigne EL, Nasr B, Gentric JC, Guegan M, Poulhazan E, Bressollette L, Lacut K, Couturaud F, Didier R. Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study. Thromb Haemost 2022; 122:1744-1756. [PMID: 35716659 DOI: 10.1055/s-0042-1748889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Steve Raoul Noumegni
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Vincent Mansourati
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Cécile Tromeur
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Raphael Le Mao
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Clément Hoffmann
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Emmanuelle Le Moigne
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Bahaa Nasr
- Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
| | - Jean-Christophe Gentric
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Neuroradiology, Brest Teaching Hospital, Brest, France
| | - Marie Guegan
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Elise Poulhazan
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Luc Bressollette
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Karine Lacut
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Francis Couturaud
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Romain Didier
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
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Noumegni SR, Didier R, Mansourati V, Moigne EL, Mao RL, Hoffmann C, Moreuil CD, Tromeur C, Roux PYL, Nasr B, Gentric JC, Guegan M, Poulhazan E, Lacut K, Bressollette L, Couturaud F. Risk Factors for Major Adverse Cardiovascular Events and Major Adverse Limb Events after Venous Thromboembolism: A Large Prospective Cohort Study. Semin Thromb Hemost 2022; 48:465-480. [PMID: 35772402 DOI: 10.1055/s-0042-1748152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is an increased risk of arterial events including major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after venous thromboembolism (VTE). However, their risk factors remain little explored. METHODS We aimed to determine the risk factors for MACE (acute coronary syndrome/stroke/cardiovascular death) and MALE (limb ischemia/critical limb ischemia/non-traumatic amputation/any limb revascularization) after VTE. Competing risk models (Fine-Gray) were used in a multicenter prospective cohort of 4,940 patients (mean age: 64.6 years and median follow-up: 64 months). RESULTS MACE occurred in 17.3% of participants (2.35% per patient-years) and MALE in 1.7% (0.27% per patient-years). In multivariable analysis, the identified risk factors for MACE were the age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.38-2.91), age >65 years (vs. <50 years, HR 4.85, 95% CI: 3.35-7.02), pulmonary embolism + deep vein thrombosis (DVT) (vs. isolated-DVT, HR: 1.25, 95% CI: 1.02-1.55), unprovoked-VTE (vs. transient risk factor associated-VTE, HR: 1.29, 95% CI: 1.04-1.59), current tobacco use (vs. never, HR: 1.45, 95% CI: 1.07-1.98), hypertension (HR: 1.61, 95% CI: 1.30-1.98), past history of symptomatic atherosclerosis (HR: 1.52, 95% CI: 1.17-1.98), heart failure (HR: 1.71, 95% CI: 1.21-2.42), atrial fibrillation (HR: 1.55, 95% CI: 1.15-2.08), and vena cava filter insertion (HR: 1.46, 95% CI: 1.03-2.08). The identified risk factors for MALE were the age of 50-65 years (vs. <50 years, HR: 3.49, 95% CI: 1.26-9.65) and atrial fibrillation (HR: 2.37, 95% CI: 1.15-4.89). CONCLUSIONS Risk factors for MACE and MALE after VTE included some traditional cardiovascular risk factors, patient's comorbidities, and some characteristics of VTE.
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Affiliation(s)
- Steve Raoul Noumegni
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Romain Didier
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Vincent Mansourati
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Emmanuelle Le Moigne
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Raphael Le Mao
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Clément Hoffmann
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Claire De Moreuil
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Cécile Tromeur
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Pierre-Yves Le Roux
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Nuclear Medicine, Brest Teaching Hospital, Brest, France
| | - Bahaa Nasr
- Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
| | - Jean-Christophe Gentric
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Neuroradiology, Brest Teaching Hospital, Brest, France
| | - Marie Guegan
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Elise Poulhazan
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Karine Lacut
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Luc Bressollette
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Francis Couturaud
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
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Noumegni SR, Le Mao R, de Moreuil C, Hoffmann C, Le Moigne E, Tromeur C, Mansourati V, Nasr B, Gentric JC, Guegan M, Poulhazan E, Bressollette L, Lacut K, Didier R, Couturaud F. Anticoagulation for VTE. Chest 2022; 162:1147-1162. [DOI: 10.1016/j.chest.2022.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/15/2022] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
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Risk factors of arterial thrombotic events after unprovoked venous thromboembolism, and after cancer associated venous thromboembolism: A prospective cohort study. Thromb Res 2022; 214:93-105. [DOI: 10.1016/j.thromres.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
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Maraveyas A, Beyer‐Westendorf J, Lee AY, Mantovani LG, De Sanctis Y, Abdelgawwad K, Fatoba S, Bach M, Cohen AT. Cancer-Associated ThrOmboSIs - Patient-Reported OutcoMes With RivarOxaban (COSIMO) - Baseline characteristics and clinical outcomes. Res Pract Thromb Haemost 2021; 5:e12604. [PMID: 34877446 PMCID: PMC8633229 DOI: 10.1002/rth2.12604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with cancer-associated thrombosis (CAT) have a high risk of recurrent venous thromboembolic events, which contribute to significant morbidity and mortality. Direct oral anticoagulants may provide a convenient treatment option for these patients. OBJECTIVES To assess clinical characteristics and outcomes of patients with active cancer changing to rivaroxaban after ≥4 weeks of standard therapy for the treatment of venous thromboembolism (VTE) in clinical practice. This analysis focused on secondary outcomes of Cancer-associated thrOmboSIs - Patient-reported outcoMes with rivarOxaban (COSIMO). PATIENTS COSIMO was a multinational, prospective, noninterventional, single-arm cohort study. Overall, 505 patients received at least one dose of rivaroxaban; 96.6% changing from low-molecular-weight heparin, 1.6% from a vitamin K antagonist, and 1.8% from fondaparinux. RESULTS Most patients had solid tumors (n = 449; 88.9%) and approximately half of these patients had metastases. The qualifying venous thromboembolic event was deep vein thrombosis (DVT) in 45.3% of patients, pulmonary embolism (PE) in 37.2% of patients, DVT with PE in 9.7% of patients, and catheter-associated DVT in 7.5% of patients. Approximately 75.1% of patients received rivaroxaban for at least 3 months; 150 (29.7%) patients received concomitant chemotherapy during the study. VTE recurrence, major bleeding, nonmajor bleeding, and major adverse cardiovascular events occurred in 18 (3.6%), 18 (3.6%), 81 (16.0%), and 12 (2.4%) patients, respectively. CONCLUSIONS In patients with CAT who changed to rivaroxaban treatment after ≥4 weeks of standard therapy, the observed incidence proportions of recurrent VTE and bleeding events were in keeping with the recognized effectiveness and safety profile of rivaroxaban for the treatment of CAT.
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Affiliation(s)
- Anthony Maraveyas
- Joint Centre for Cancer StudiesHull York Medical SchoolQCOHCastle Hill HospitalHullUK
| | - Jan Beyer‐Westendorf
- Thrombosis Research UnitDepartment of Medicine IDivision HematologyUniversity Hospital “Carl Gustav Carus” DresdenDresdenGermany
| | - Agnes Y. Lee
- Division of HematologyUniversity of British ColumbiaBritish Columbia Cancer AgencyVancouverBCCanada
| | | | | | | | | | | | - Alexander T Cohen
- Department of Haematological MedicineGuys and St Thomas' NHS Foundation TrustKing's College LondonLondonUK
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Accelerated fibrin clot degradation is associated with arterial thromboembolism in patients following venous thrombosis: a cohort study. Sci Rep 2021; 11:21003. [PMID: 34702844 PMCID: PMC8548328 DOI: 10.1038/s41598-021-00411-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/24/2021] [Indexed: 11/08/2022] Open
Abstract
Several lines of evidence have suggested that patients following venous thromboembolism (VTE) are at higher risk of arterial thromboembolism (ATE). Prothrombotic fibrin clot characteristics were reported in individuals with cardiovascular risk factors. We investigated whether specific fibrin clot properties measured after 3-4 months of anticoagulation characterize VTE patients with subsequent ATE. We enrolled 320 patients following VTE aged below 70 years (median age, 46). Ten patients were lost to follow-up. ATE occurred in 21 individuals after a median 54 (31-68) months during a follow-up of 87.5 months (incidence 0.94%; 95% confidence interval [CI], 0.59-1.4 per patient-year). Patients with ATE had faster fibrin clot degradation, reflected by maximum rate of D-dimer increase during plasma clot lysis induced by tissue-type plasminogen activator (D-Drate) at baseline. Clot permeability, turbidimetric variables, clot lysis time, and thrombin generation were unrelated to ATE. Univariable Cox proportional hazards analysis showed that age, diabetes, and D-Drate were risk factors for subsequent ATE. Increased D-Drate (by 0.001 mg/L/min; hazard ratio, 1.08; 95% CI 1.02-1.14) was an independent predictor of ATE after adjustment for potential confounders. Faster fibrin clot degradation at 3 months since VTE may increase the risk of ATE among VTE patients during follow-up.
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Lobastov KV, Navasardyan AR, Schastlivtsev IV. Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-06-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim. To assess the duration of the anticoagulant treatment of venous thromboembolism (VTE) in various categories of patients in real clinical practice through survey of practitioners, as well as correspondence of the duration with current clinical guidelines.Material and methods. Data obtained from electronic survey of practicing surgeons as part of a commercial brand assessment (Brand Adoption Monitor) was studied. Survey was carried out by the "Validata” analytical agency at the request and with the financial support of Bayer. Inpatient and outpatient vascular surgeons, as well as general outpatient surgeons were invited to complete the electronic questionnaire. The number of interviewed specialists was 100: 50 inpatient vascular surgeons and 50 outpatient specialists, among whom the share of vascular surgeons (phlebologists, angi-ologists) was about 20%. The study was completed in 20 cities of Russia with a population of at least 200,000 people from all federal districts except the North Caucasus and the Republic of Crimea. The selection criteria for participants were: work experience in the specialty ≥3 years, work experience at the current organization >6 months, ≥5 patients with VTE during in the last month.Results. In total, 104 doctors were surveyed during the period from December 11, 2019 to January 20, 2020, of which 50 were inpatient vascular surgeons and 54 were from outpatient setting. According to the survey of vascular surgeons in hospitals, 75% (6 [5;10]) of patients were hospitalized with a primary episode of VTE and 25% (2 [1;4]) with a recurrent thrombotic event. In an outpatient surgeon, 27.5% (3 [2;5]) of patients were treated in an outpatient setting without hospitalization, 34.7% (3 [2;5]) came to an appointment immediately after discharge from the hospital and 38.8% (2 [1;4]) were a repeat visit regarding a previous VTE. Most often, surgeons observed episodes of clinically unprovoked VTE in 27.3% of cases, thrombotic events provoked by major transient risk factors were 12.2%, event provoked by small transient risk factors were 13.3% and events provoked by small persistent risk factors were 12.6%, while cancer-associated thrombosis represented 13.5%. Most surgeons chose to prescribe anticoagulant therapy beyond 3 months. About half of the specialists prescribed therapy for a year or longer for cancer-associated thrombosis and recurrent VTE. When treating the first episode of clinically unprovoked VTE, about half of the respondents chose anticoagulation for a period of 3 to 6 months. About 60% of specialists prescribed anticoagulant therapy for a period of 3 to 6 months to patients with minor transient or persistent risk factors and patients with VTE provoked by major transient risk factor (trauma or surgery).Conclusion. Correspondence of the duration of anticoagulant therapy in real clinical practice with the international clinical guidelines varies within 450% range and, on average, does not exceed 30%. This discrepancy was both in situations when the duration of therapy was lower than recommended, but also in situations when treatment extension would not have been recommended.
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Noumegni SR, Hoffmann C, Tromeur C, Didier R, Bressollette L, Lacut K, Couturaud F. Risk Factors of Arterial Events in Patients with Venous Thromboembolism: A Systematic Review and Meta-Analysis. Thromb Haemost 2021; 122:590-599. [PMID: 34264517 DOI: 10.1055/s-0041-1732300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND If recent studies suggested that arterial ischemic events in patients with venous thromboembolism (VTE) are more frequent than in the general population without VTE, whether patients with VTE have different risk factors of arterial events than classic known cardiovascular risk factors remain undefined. Through this systematic review and meta-analysis, we aimed to identify risk factors of arterial ischemic events in patients with VTE. METHODS We searched PubMed, EMBASE, and Cochrane databases to identify cohort studies published between January 1, 2000, and December 31, 2020, reporting risk factors of arterials ischemic events in patients with VTE. Random-effect models meta-analysis served to get the pooled hazard ratio (HR) and 95% confidence interval (CI) of each risk factor identified. RESULTS We screened 1,467 records of which 18 were finally included in systematic review and 10 in meta-analyses. Adjusted HR for 9 factors were included in meta-analysis. Male gender (HR: 1.38; 95% CI: 1.28-1.49), diabetes (HR: 1.65; 95% CI: 1.28-2.12), hypertension (HR: 1.38; 95% CI: 1.04-1.84), previous atherothrombotic event (HR: 3.22; 95% CI: 1.12-9.23), chronic kidney disease (HR: 1.41; 95% CI: 1.05-1.88), cancer (HR: 1.72; 95% CI: 1.41-2.09), and unprovoked VTE (HR: 1.88; 95% CI: 1.37-2.57) were the identified risk factors of arterial events in VTE population after meta-analysis. CONCLUSION Risk factors of arterial events in patients with VTE include usual cardiovascular risk factors and other risk factors that are related to VTE such as cancer and unprovoked VTE.
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Affiliation(s)
- Steve Raoul Noumegni
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France.,EA3878 (GETBO), Groupe d'Etude de la Thrombose de Bretagne Occidentale, Brest University, Brest, France
| | - Clément Hoffmann
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France.,EA3878 (GETBO), Groupe d'Etude de la Thrombose de Bretagne Occidentale, Brest University, Brest, France
| | - Cécile Tromeur
- EA3878 (GETBO), Groupe d'Etude de la Thrombose de Bretagne Occidentale, Brest University, Brest, France.,Internal Medicine and Pneumology Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Romain Didier
- Internal Medicine and Pneumology Department, Brest Teaching Hospital, Brest University, Brest, France.,Cardiology Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Luc Bressollette
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France.,EA3878 (GETBO), Groupe d'Etude de la Thrombose de Bretagne Occidentale, Brest University, Brest, France
| | - Karine Lacut
- EA3878 (GETBO), Groupe d'Etude de la Thrombose de Bretagne Occidentale, Brest University, Brest, France.,Internal Medicine and Pneumology Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Francis Couturaud
- EA3878 (GETBO), Groupe d'Etude de la Thrombose de Bretagne Occidentale, Brest University, Brest, France.,Internal Medicine and Pneumology Department, Brest Teaching Hospital, Brest University, Brest, France
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Wang PC, Chen TH, Chung CM, Chen MY, Chang JJ, Lin YS, Chu PH, Peng YS, Lin MS. The effect of deep vein thrombosis on major adverse limb events in diabetic patients: a nationwide retrospective cohort study. Sci Rep 2021; 11:8082. [PMID: 33850207 PMCID: PMC8044219 DOI: 10.1038/s41598-021-87461-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Little is known about the association between deep vein thrombosis (DVT) and arterial complications in patients with type 2 diabetes (T2DM). The aim of this retrospective cohort study was to assess the influence of prior DVT on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in T2DM. A total of 1,628,675 patients with T2DM with or without a history of DVT from 2001 to 2013 were identified in the National Health Insurance Research Database of Taiwan. Before matching, the patients in the DVT group (n = 2020) were older than the control group (66.3 vs. 58.3 years). Patients in the DVT group were more likely to be female than the control group (54.3% vs. 47.5%). Before matching, the DVT group had higher prevalence of most comorbidities, more prescription of antiplatelet, antihypertensive agents and insulins, but less prescription of metformin and sulfonylurea. During a mean follow-up of 5.2 years (standard deviation: 3.9 years), the matched DVT group (n = 2017) have a significantly increased risk of MALE (8.4% vs. 5.2%; subdistribution hazard ratio [SHR] 1.60, 95% CI 1.34-1.90), foot ulcer (5.2% vs. 2.6%, SHR 1.96, 95% CI 1.57-2.45), gangrene (3.4% vs. 2.3%, SHR 1.44, 95% CI 1.10-1.90) and amputation (2.5% vs. 1.7%; SHR 1.42, 95% CI 1.03-1.95) than the 10,085 matched controls without DVT. They also tended to have a greater risk of all-cause mortality (38.1% vs. 33.1%; hazard ratio [HR] 1.18, 95% CI 1.09-1.27) and systemic thromboembolism (4.2% vs. 2.6%; SHR 1.56, 95% CI 1.22-1.99), respectively. We showed the presence of DVT may be associated with an increased risk of MALEs, major amputation, and thromboembolism, contributing to a higher mortality rate in T2DM.
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Affiliation(s)
- Po-Chang Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chang-Min Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Shing Peng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, Sec. West Chai-Pu Road, Pu-TZ City, 61363, Chiayi, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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