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Thromb Haemost 2022; 122(10): 1744-1756
DOI: 10.1055/s-0042-1748889
Stroke, Systemic or Venous Thromboembolism

Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study

Steve Raoul Noumegni 
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Vincent Mansourati
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
3   Department of Cardiology, Brest Teaching Hospital, Brest, France
,
Cécile Tromeur
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Raphael Le Mao
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Clément Hoffmann
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Emmanuelle Le Moigne
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Bahaa Nasr
4   Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
,
Jean-Christophe Gentric
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
5   Department of Neuroradiology, Brest Teaching Hospital, Brest, France
,
Marie Guegan
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Elise Poulhazan
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Luc Bressollette
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Karine Lacut
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Francis Couturaud
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Romain Didier
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
3   Department of Cardiology, Brest Teaching Hospital, Brest, France
› Author Affiliations Funding The study was supported by grants from the “Programme Hospitalier de Recherche Clinique” (French Department of Health), the Foundation “Archipel Santé,” and the sponsor was the Brest Teaching Hospital. The funding source was not involved in designing or conducting the study, collecting, managing, analyzing or interpreting the data, preparing, reviewing or approving the manuscript, or deciding to submit this for publication. An academic steering committee led by F.C. assumed overall responsibility for all these steps.
› Further Information
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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.

Keywords

venous thromboembolism - cardiovascular deaths - cardiovascular mortality - risk factors - predictor - prospective cohort

Ethical Approval and Consent to Participate

The study was approved by the Ethics Committee of Brest University Teaching Hospital (CCP-Ouest 6–390) with a last amendment approved on November 20, 2013 under reference number: EDITH II/RB 05.003. Administrative approvals were also obtained from authorities of the Brest University Teaching Hospital and all other recruiting centers. All participants singed a consent form.


Availability of Data and Materials

The data that support the findings of this study are available from S.R.N. or F.C., upon reasonable request.


Author Contributions

Conception and design: S.R.N., F.C., L.B., R.D.; acquisition of data: E.P.; data analysis: S.R.N.; analysis and interpretation of data: S.R.N., F.C., L.B.; manuscript drafting: S.R.N.; manuscript revision: all authors; approved the final version of the manuscript: all authors; obtaining funding: F.C.; administrative, technical, and material support: F.C., C.T., R.D.; study supervision: F.C.; full access to all the data of the study: F.C., S.R.N.; responsibility for all aspect of the study, reliability, and freedom from bias of the data presented: all authors.




Publication History

Received: 23 December 2021

Accepted: 13 March 2022

Article published online:
18 June 2022

© 2022. Thieme. All rights reserved.

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