Venous Thromboembolism Outcomes by Geographic Region and Self-Reported Race: Insights from the RIETE Registry

Abstract

Background

Venous thromboembolism (VTE) outcomes are influenced by various factors, including race and geographic location. This study aimed to evaluate the associations between race, geographic location, and VTE-related outcomes using real-world data.

Methods

We analyzed data from 42,206 patients with acute VTE enrolled in the RIETE registry between June 2016 and June 2024. Patients were categorized by self-reported race/ethnicity: White (40,258), Arab (995), Asian (689), and Black (264). Baseline characteristics, comorbidities, treatment strategies, and outcomes (including recurrences, major bleeding, and mortality) were compared across groups and regions. Multivariable analyses were performed to adjust for confounders, including geographic location and comorbidities.

Results

Arabic and Asian patients were generally younger, had fewer comorbidities, and were more likely to receive direct oral anticoagulants than White patients. In unadjusted analysis, non-White patients had higher rates of deep vein thrombosis (DVT) recurrence and mortality. After multivariable adjustment, most differences disappeared. Notably, White patients enrolled in Asian centers had higher DVT recurrence (4.54 vs. 1.10/100 patient-years, respectively) and mortality rates (27.9 vs. 8.88/100 patient-years, respectively) than those in European centers, and Arab patients in Asia had higher mortality compared to those in Europe (24.1 vs. 8.26/100 patient-years, respectively).

Conclusion

Geographic location, likely representing healthcare infrastructure, had a greater influence on VTE outcomes than self-reported race alone.

Keywords

race - VTE - geography

^* The details of the RIETE Investigators is provided in the [Supplementary Appendix] (available in the online version).

Publikationsverlauf

Eingereicht: 05. April 2025

Angenommen: 18. Mai 2025

Accepted Manuscript online:
19. Mai 2025

Artikel online veröffentlicht:
24. Juni 2025

• References

• 1 Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 3-14
• 2 Raskob GE, Angchaisuksiri P, Blanco AN. et al; ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014; 34 (11) 2363-2371
• 3 Dowling NF, Austin H, Dilley A, Whitsett C, Evatt BL, Hooper WC. The epidemiology of venous thromboembolism in Caucasians and African-Americans: the GATE Study. J Thromb Haemost 2003; 1 (01) 80-87
• 4 White RH, Zhou H, Murin S, Harvey D. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 2005; 93 (02) 298-305
• 5 Schneider D, Lilienfeld DE, Im W. The epidemiology of pulmonary embolism: racial contrasts in incidence and in-hospital case fatality. J Natl Med Assoc 2006; 98 (12) 1967-1972
• 6 White RH, Dager WE, Zhou H, Murin S. Racial and gender differences in the incidence of recurrent venous thromboembolism. Thromb Haemost 2006; 96 (03) 267-273
• 7 Heit JA, Beckman MG, Bockenstedt PL. et al; CDC Thrombosis and Hemostasis Centers Research and Prevention Network. Comparison of characteristics from White- and Black-Americans with venous thromboembolism: a cross-sectional study. Am J Hematol 2010; 85 (07) 467-471
• 8 de Souza RJ, Anand SS. Cardiovascular disease in Asian Americans: unmasking heterogeneity. J Am Coll Cardiol 2014; 64 (23) 2495-2497
• 9 Deitelzweig SB, Lin J, Johnson BH, Schulman KL. Venous thromboembolism in the US: does race matter?. J Thromb Thrombolysis 2011; 31 (02) 133-138
• 10 Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9 (01) 85-91
• 11 Tang Y, Sampson B, Pack S. et al. Ethnic differences in out-of-hospital fatal pulmonary embolism. Circulation 2011; 123 (20) 2219-2225
• 12 Bounameaux H, Rosendaal FR. Venous thromboembolism: why does ethnicity matter?. Circulation 2011; 123 (20) 2189-2191
• 13 Xu Y, Siegal DM, Anand SS. Ethnoracial variations in venous thrombosis: Implications for management, and a call to action. J Thromb Haemost 2021; 19 (01) 30-40
• 14 Schulman S, Kearon C, Kakkar AK. et al; RE-MEDY Trial Investigators, RE-SONATE Trial Investigators. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013; 368 (08) 709-718
• 15 Schulman S, Kakkar AK, Goldhaber SZ. et al; RE-COVER II Trial Investigators. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation 2014; 129 (07) 764-772
• 16 Bauersachs R, Berkowitz SD, Brenner B. et al; EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010; 363 (26) 2499-2510
• 17 Agnelli G, Becattini C, Meyer G. et al; Caravaggio Investigators. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 2020; 382 (17) 1599-1607
• 18 Agnelli G, Buller HR, Cohen A. et al; AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013; 369 (09) 799-808
• 19 Büller HR, Décousus H, Grosso MA. et al; Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 2013; 369 (15) 1406-1415
• 20 Wang Y, Wang C, Chen Z. et al; Chinese EINSTEIN Investigators. Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies. Thromb J 2013; 11 (01) 25
• 21 Yamada N, Hirayama A, Maeda H. et al. Oral rivaroxaban for Japanese patients with symptomatic venous thromboembolism—the J-EINSTEIN DVT and PE program. Thromb J 2015; 13: 2
• 22 Okumura Y, Fukuda I, Nakamura M. et al; J'xactly Investigators. A multicenter prospective observational cohort study to investigate the effectiveness and safety of rivaroxaban in Japanese venous thromboembolism patients (the J'xactly Study). Circ J 2020; 84 (11) 1912-1921
• 23 Nakamura M, Nishikawa M, Komuro I. et al. Apixaban for the treatment of Japanese subjects with acute venous thromboembolism (AMPLIFY-J Study). Circ J 2015; 79 (06) 1230-1236
• 24 Lewis C, Cohen PR, Bahl D, Levine EM, Khaliq W. Race and ethnic categories: a brief review of global terms and nomenclature. Cureus 2023; 15 (07) e41253
• 25 Flanagin A, Frey T, Christiansen SL. AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA 2021; 326 (07) 621-627
• 26 Mersha TB, Abebe T. Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum Genomics 2015; 9 (01) 1
• 27 Bikdeli B, Jimenez D, Hawkins M. et al; RIETE Investigators. Rationale, design and methodology of the computerized registry of patients with venous thromboembolism (RIETE). Thromb Haemost 2018; 118 (01) 214-224
• 28 Assaf N. et al. Prevalence of thrombophilia-associated mutations and their clinical significance in a large cohort of Lebanese patients. Meta Gene 2021; 29: 100936
• 29 Jin X, Kinoshita S, Kuma H. et al. Reduced activity of protein S in plasma: a risk factor for venous thromboembolism in the Japanese population. Clin Appl Thromb Hemost 2021 ;27:10760296211033908
• 30 Zhu XJ, Liu ZY, Wang PW. et al. Congenital thrombophilia in East-Asian venous thromboembolism population: a systematic review and meta-analysis. Res Pract Thromb Haemost 2023; 7 (06) 102157