Increased risk of arterial thromboembolism after a prior episode of venous thromboembolism: results from the Prevention of REnal and Vascular ENd stage Disease (PREVEND) Study

Abstract

Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. SummaryLarge population-based studies are needed to establish the magnitude and duration of the recently suggested association between arterial and venous thromboembolism. In 1997-98, all inhabitants of Groningen, the Netherlands, aged 28-75 years (n = 85 421), were invited to participate in a study that followed and monitored responding subjects (n = 40 856) for venous and arterial thromboembolism until 2009. Thromboembolism was verified with national registries of hospital discharge diagnoses and death certificates, anticoagulation clinic and medical records. During a median followup of 10Á7 years, 549 participants developed venous thromboembolism and 3283 developed arterial thromboembolism. Annual incidence of arterial thromboembolism after venous thromboembolism was 2Á03% [95% confidence interval (CI), 1Á48-2Á71], compared to 0Á87% (95% CI, 0Á84-0Á90) in subjects without venous thromboembolism. The hazard ratio (HR) of arterial thromboembolism after venous thromboembolism was 1Á40 (95% CI, 1Á04-1Á88) after adjustment for age, sex and cardiovascular risk factors. This risk was highest during the first year after venous thromboembolism [annual incidence, 3Á00% (95% CI, 1Á64-5Á04); adjusted HR, 2Á01 (95% CI, 1Á19-3Á40)] and after an unprovoked event [annual incidence, 2Á53% (95% CI, 1Á68-3Á66); adjusted HR, 1Á62 (95% CI, 1Á11-2Á34)]. This study showed that subjects with venous thromboembolism are at increased risk for arterial thromboembolism, particularly in the first year after venous thromboembolism and after an unprovoked event.

Increased risk of CVD after VT is determined by common etiologic factors

“…3,11 However, in our study we found the opposite. A possible explanation for this For personal use only.…”

“…As patients are often admitted to hospital for a short time after VT and are closely monitored thereafter, it is possible that increased medicalization can explain the high number of arterial cardiovascular diagnoses made in the first year after VT onset. This, too, would explain the difference in our findings compared with those from the study by Van Schouwenburg et al, 11 as we only used hard endpoints.…”

“…In a study by Van Schouwenburg et al, 11 a broad definition of CVD was used that included subacute ischemic heart disease and angioplasty. As patients are often admitted to hospital for a short time after VT and are closely monitored thereafter, it is possible that increased medicalization can explain the high number of arterial cardiovascular diagnoses made in the first year after VT onset.…”

“…6,9,10 However, either because of a lack of information on classical cardiovascular risk factors (apart from age and sex) or because of a broad definition of CVD (eg, otherwise unexplained death, angina, transient ischemic attack, and angioplasty), no study has yet provided estimates of the risk of myocardial infarction and ischemic stroke after VT adjusted for shared risk factors. [3][4][5]11 In addition, other health determinants that may affect the risk of both VT and CVD, such as socioeconomic status, diet, and alcohol consumption, have not previously been taken into account. [12][13][14][15] In a large prospective cohort study (n .…”

Non-vitamin K antagonist oral anticoagulants (NOACs) for the management of venous thromboembolism

“…However, many of the risk factors for arterial thrombosis are also risk factors for VTE, and in addition VTEs have additional risk factors such as obesity and cancer 4 5. Indeed, VTE is a risk factor for subsequent arterial thrombosis 6. Some risk factors (such as orthopaedic surgery, certain types of valve disease and cardioversion for atrial fibrillation (AF)) are so strong, that anticoagulation is mandatory 7…”