Predictors of Recurrent Venous Thromboembolism or Arterial Thrombotic Events during and after Anticoagulation for a First Venous Thromboembolism

Steve Raoul Noumegni; Cécile Tromeur; Clément Hoffmann; Raphael Le Mao; Emmanuelle Le Moigne; Claire de Moreuil; Vincent Mansourati; Bahaa Nasr; Jean-Christophe Gentric; Marie Guegan; Elise Poulhazan; Luc Bressollette; Karine Lacut; Romain Didier; Francis Couturaud

doi:10.1055/s-0042-1757899

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2023; 49(07): 688-701
DOI: 10.1055/s-0042-1757899

Review Article

Predictors of Recurrent Venous Thromboembolism or Arterial Thrombotic Events during and after Anticoagulation for a First Venous Thromboembolism

Authors

Steve Raoul Noumegni

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Cécile Tromeur

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Clément Hoffmann

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Raphael Le Mao

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Emmanuelle Le Moigne

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Claire de Moreuil

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Vincent Mansourati

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

³Department of Cardiology, Brest Teaching Hospital, Brest, France
Bahaa Nasr

⁴Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
Jean-Christophe Gentric

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

⁵Department of Neuroradiology, Brest Teaching Hospital, Brest, France
Marie Guegan

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Elise Poulhazan

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Luc Bressollette

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Karine Lacut

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
Romain Didier

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

³Department of Cardiology, Brest Teaching Hospital, Brest, France
Francis Couturaud

¹Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France

²Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France

Abstract

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.

Keywords

recurrent venous thromboembolism - arterial thrombotic event - risk factor - predictor - prospective cohort

Full Text

References

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