Abstract
Studies on short-term prognosis of venous thromboembolism (VTE) that take family history
of VTE and Charlson Comorbidity Index (CCI) into account are sparse. The aim was to
investigate the importance of family history of VTE and CCI for short-term mortality
after a first episode of VTE. Using Swedish medical databases, we conducted a 90-day
nationwide cohort study of 41,700 Swedish born patients with a first-time VTE (July
2005–August 2012). Patients diagnosed with VTE and prescribed anticoagulant treatment
were included. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were
determined with Cox regression. Patients with first-degree (sibling/parent) family
history of VTE (n = 11,405, 27.4%) had significantly lower CCI than those without family history. Independent
risk factors for 90-day mortality in the adjusted model were: female sex (HR = 1.19,
95% CI: 1.09–1.29), increasing age (HR = 1.02, 95% CI: 1.01–1.02 per year), pulmonary
embolism (HR = 1.21, 95% CI: 1.11–1.32) or combined pulmonary embolism and deep venous
thrombosis (HR = 1.60, 95% CI: 1.27–2.01) compared with deep venous thrombosis, CCI = 1
(HR = 2.93, 95% CI: 2.32–3.72), CCI = 2 (HR = 8.65, 95% CI: 7.16–10.46) or CCI = 3
(HR = 22.25, 95% CI: 18.73–26.44) compared with CCI = 0. Having one or two or more
affected first-degree relatives with VTE was associated with lower mortality, HR = 0.83
(95% CI: 0.74–0.92) and HR = 0.65 (95% CI: 0.51–0.85), respectively. The mortality
rate was 0.70% in patients with a CCI of zero. In receiver operating characteristic
(ROC) analysis, the area under the ROC curve for CCI was 0.84 (0.83–0.95). Family
history of VTE is associated with lower mortality while CCI is a strong predictor
for short-term mortality in VTE. Co-morbidities are important for risk assessment
of VTE.
Keywords
venous thromboembolism - pulmonary embolism - venous thrombosis - mortality - epidemiology
