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Predictors of Recurrent Venous Thromboembolism or Arterial Thrombotic Events during and after Anticoagulation for a First Venous ThromboembolismFunding 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.
After first episodes of venous thromboembolism (VTE), patients are at increased risk of recurrent VTE and arterial thrombotic events (ATE) compared with the general population, two disorders that are influenced by anticoagulation. However, risk factors of these conditions occurring during and after anticoagulation are little described. Using cause-specific hazard regression models, we aimed to determine risk factors of the composite outcome recurrent VTE/ATE, and separately recurrent VTE or ATE, during and after anticoagulation in patients with first episodes of VTE from a prospective cohort. Hazard ratios (HRs) are given with 95% confidence intervals (CIs). A total of 2,011 patients treated for at least 3 months were included. A total of 647 patients had recurrent VTE/ATE (incidence: 4.69% per patient-years) during overall follow-up (median: 92 months). Of these events, 173 occurred during anticoagulation (incidence: 3.67% per patient-years). Among patients free of events at the end of anticoagulation, 801 had a post-anticoagulation follow-up ≥3 months; and 95 had recurrent VTE/ATE (incidence: 1.27% per patient-years). After adjustment for confounders, cancer-associated VTE (HR: 2.64, 95% CI: 1.70–4.11) and unprovoked VTE (HR: 1.95, 95% CI: 1.35–2.81) were the identified risk factors of recurrent VTE/ATE during anticoagulation (vs. transient risk factor–related VTE). Risk factors of recurrent VTE/ATE after anticoagulation included 50 to 65 years of age (vs. < 50, HR: 1.99, 95% CI: 1.04–3.81), older than 65 years (vs. < 50, HR: 5.28, 95% CI: 3.03–9.21), and unprovoked VTE (vs. transient risk factor–related VTE, HR: 2.06, 95% CI: 1.27–3.34). Cancer-associated VTE and unprovoked VTE are the main risk factors of recurrent VTE/ATE during anticoagulation, while older age and unprovoked VTE mainly predict the risk of these events after anticoagulation.
Keywordsrecurrent venous thromboembolism - arterial thrombotic event - risk factor - predictor - prospective cohort
Ethical Approval and Consent to Participate
The study was approved by the Brest Scientific and Ethical Board (Brest Personal Protection Committee), with the 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 Teaching Hospital. All participants signed the 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.
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 aspects of the study, reliability, and freedom from bias of the data presented: all authors.
Article published online:
17 October 2022
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