Thromb Haemost 2019; 119(01): 048-055
DOI: 10.1055/s-0038-1676347
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Association of Short-Term Mortality of Venous Thromboembolism with Family History of Venous Thromboembolism and Charlson Comorbidity Index

Bengt Zöller
1  Center for Primary Health Care Research, Lund University, Region Skåne, Malmö, Sweden
,
MirNabi Pirouzifard
1  Center for Primary Health Care Research, Lund University, Region Skåne, Malmö, Sweden
,
Jan Sundquist
1  Center for Primary Health Care Research, Lund University, Region Skåne, Malmö, Sweden
,
Kristina Sundquist
1  Center for Primary Health Care Research, Lund University, Region Skåne, Malmö, Sweden
› Author Affiliations
Funding This work was supported by grants awarded to Dr. Bengt Zöller by the Swedish Heart-Lung Foundation, ALF funding from Region Skåne awarded to Dr. Bengt Zöller and Dr. Kristina Sundquist, grants awarded to Dr. Bengt Zöller and Dr. Kristina Sundquist by the Swedish Research Council and grants awarded to Dr. Jan Sundquist by King Gustaf V and Queen Victoria's Foundation of Freemasons. The funders had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Further Information

Publication History

29 June 2018

16 October 2018

Publication Date:
31 December 2018 (online)

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.

Supplementary Material