Incidence of major adverse cardiovascular events among patients with provoked and unprovoked venous thromboembolism: Findings from the Registro Informatizado de Enfermedad Tromboembólica Registry

Golemi, Iva; Cote, Lauren; Iftikhar, Omer; Tafur, Alfonso; Bikdeli, Behnood; Fernández‐Capitán, Carmen; Otero, Remedios; Monréal, Manuel; Micco, Pierpaolo Di; Reis, Abílio; Caprini, Joseph A.; Adarraga, MD; Aibar, M.A.; Aibar, Jesús; Amado, Cristina; Arcelus, J.I.; Azcárate, P.; Ballaz, Aitor; Barba, Raquel; Barrón, M.; Barrón‐Andrés, B.; Bascuñana, J.; Blanco-Molina, Ángeles; Camon, A.M.; Carrasco, C.; Castro, Joaquín; Ancos, Cristina de; Toro, J. del; Demelo, P; Díaz-Pedroche, M.C.; Díaz-Peromingo, J.A.; Díaz-Simón, Raquel; Encabo, Mercedes; Falgá, C.; Farfán, AI; Fernández‐Criado, MC; Fidalgo, M.A.; Font, Carme; Font, Llorenç; García, M.A.; García‐Bragado, F.; García-Morillo, Marcial; García-Raso, Aránzazu; Gavín, Olga; García‐Manso, Ignacio Gayá; Gayol, M.C.; Gil-Díaz, Aída; Guirado, L.; Gómez, Vicente; González‐Martínez, José; Grau, E; Gutiérrez, J.; Blasco, Luis Manuel Hernández; Iglesias, Marina; Jara‐Palomares, Luis; Jaras, M.J.; Jiménez, David; Jou, Inés; Joya, M.D.; Lalueza, Antonio; Lima, Jorge Roberto Perrout de; Llamas, Pilar; Lobo, José Luís; López-Jiménez, Luciano; López-Miguel, Patricia; López‐Núñez, JJ; López‐Reyes, Raquel; López‐Sáez, Juan Bosco; Lorente, Manuel; Lorenzo, Alicia; Loring, Mónica; Lumbierres, Marina; Madridano, Olga; Maestre, Ana; Marchena, Pablo Javier; Martín-Guerra, Javier Miguel; Fernández, Miguel Martín; Mellado, Meritxell; Morales, M.V.; Nieto, José Antonio; Núñez, Marta; Olivares, MC; Otalora, S.; Pedrajas, José María; Pellejero, G; Pérez-Pinar, M.; Pérez‐Rus, Gloria; Peris, M.L.; Pesce, Maria Lourdes; Porras, José Antonio; Rivas, Agustina; Rodríguez‐Dávila, M.A.; Rodríguez-Fernández, Lucía; Rodríguez-Hernández, Ana; Rodríguez‐Martín, Carmela; Rubio, Carmen Ma.; Ruiz-Alcaraz, S.; Ruiz-Artacho, Pedro; Ruiz-Ruiz, Justo; Ruiz-Sada, Pablo; Sahuquillo, Joan Carles; Salazar, Vladimir Rosa; Sampériz, A.; Sánchez-Muñoz-Torrero, J.F.; Sancho, Teresa; Sanoja, I.; Soler, Silvia; Soto, Marı́a José; Suriñach, José María; Tolosa, Carles; Torres, M.I.; Trujillo‐Santos, Javier; Uresandi, Fernando; Usandizaga, Esther; Valle, Reina; Vidal, G.; Gutiérrez, Paula; Vázquez, Fernando Javier; Vilaseca, Alicia; Vanassche, Thomas; Vandenbriele, Christophe; Verhamme, Peter; Hirmerová, Jana; Malý, Radován; Salgado, E.; Benzidia, Ilham; Bertoletti, Laurent; Bura-Rivière, A.; Debourdeau, Philippe; Falvo, Nicolas; Farge‐Bancel, Dominique; Hij, A.; Mahé, I.; Moustafa, Farès; Braester, Andrei; Brenner, Benjamin; Ellis, M.; Tzoran, Inna; Barillari, Giovanni; Bilora, Franca; Bortoluzzi, Cristiano; Brandolin, Barbara; Bucherini, Eugenio; Ciammaichella, Maurizio; Dentali, Francesco; Micco, P. Di; Grandone, E.; Imbalzano, Egidio; Lessiani, Gianfranco; Maida, R.; Mastroiacovo, Daniela; Mumoli, Nicola; Hong, Ngoc Vo; Pace, F.; Parisi, Roberto; Pesavento, Raffaele; Pinelli, Massimiliano; Prandoni, Paolo; Quintavalla, Roberto; Rocci, Anna; Siniscalchi, Carmine; Tufano, Antonella; Visonà, Adriana; Skride, Andris; Sablinskis, Kristaps; Sablinskis, Matiss; Bosevski, Marijan; Zdraveska, Marija; Bounameaux, Henri; Fresa, Marco; Ney, Barbara; Mazzolai, Lucia; Ja, Caprini; Bui, Hanh My

doi:10.1016/j.jvsv.2019.03.011

Cited by 10 publications

(4 citation statements)

References 24 publications

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“…In our cohort there were no differences in the risk of ATE between patients with unprovoked VTE versus provoked VTE. This finding, though based on a relatively small number of patients, was contrary to our expectations, because several studies, including its meta-analysis, have shown that patients after unprovoked VTE were at higher risk of ATE compared to those with provoked VTE, however some reports failed to observe such differences related to the type of VTE 4 , 6 , 44 . Of note, we observed an increased fibrinogen concentration at 3 months since the event in patients with provoked VTE.…”

Section: Discussioncontrasting

confidence: 99%

Accelerated fibrin clot degradation is associated with arterial thromboembolism in patients following venous thrombosis: a cohort study

Mrozińska

Wypasek

Broniatowska

et al. 2021

Sci Rep

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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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Section: Discussioncontrasting

confidence: 99%

Accelerated fibrin clot degradation is associated with arterial thromboembolism in patients following venous thrombosis: a cohort study

Mrozińska

Wypasek

Broniatowska

et al. 2021

Sci Rep

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“…Previous studies have shown that patients with VTE and cancer have an increased risk of MACEs, which appears to be a major cause of mortality in patients with CAT. [30][31][32] These findings suggest that the influence of arterial ischemic events on clinical outcomes in patients with CAT needs to be elucidated. AEs reported in the COSIMO study were mostly cancer-or cancer therapyassociated events and were similar to those observed in the RCTs of DOACs in patients with CAT.…”

Section: All-cause Mortalitymentioning

confidence: 97%

Cancer‐Associated ThrOmboSIs – Patient‐Reported OutcoMes With RivarOxaban (COSIMO) – Baseline characteristics and clinical outcomes

Maraveyas

Beyer‐Westendorf

Lee

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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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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“…Кумулятивная частота повторных тромботических событий, увеличивающих риск летального исхода и формирования посттромботической болезни, достигает 25-45% через 5-10 лет наблюдения [5][6][7][8]. Таким образом, рецидивирующие ВТЭО наряду с увеличенным риском поражения артериального русла и повышенной вероятностью наличия фонового злокачественного новообразования определяют снижение общей продолжительности жизни после перенесенного тромбоза [9][10][11][12][13][14][15]. Летальный исход в течение 8 лет настигает 35% и 65% больных, перенесших ТГВ и ТЭЛА соответственно, что значительно превышает аналогичный скорректированный по возрасту и полу показатель в общей популяции [9].…”

Section: Introductionunclassified

Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey

Lobastov

Navasardyan²,

Schastlivtsev

2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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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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Incidence of major adverse cardiovascular events among patients with provoked and unprovoked venous thromboembolism: Findings from the Registro Informatizado de Enfermedad Tromboembólica Registry

Cited by 10 publications

References 24 publications

Accelerated fibrin clot degradation is associated with arterial thromboembolism in patients following venous thrombosis: a cohort study

Accelerated fibrin clot degradation is associated with arterial thromboembolism in patients following venous thrombosis: a cohort study

Cancer‐Associated ThrOmboSIs – Patient‐Reported OutcoMes With RivarOxaban (COSIMO) – Baseline characteristics and clinical outcomes

Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey

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