Subsequent arterial ischemic events in patients receiving anticoagulant therapy for venous thromboembolism.
Details
Serval ID
serval:BIB_F620E5CE0C65
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Subsequent arterial ischemic events in patients receiving anticoagulant therapy for venous thromboembolism.
Journal
Journal of vascular surgery. Venous and lymphatic disorders
Working group(s)
RIETE Investigators
Contributor(s)
Arcelus J.I., Arroyo M., Ballaz A., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Bedate P., Blanco-Molina A., Bueso T., Casado I., Del Molino F., Del Toro J., Falgá C., Fernández-Capitán C., Font C., Fuentes M.I., Gallego P., García-Bragado F., Gavín O., Gómez V., González J., González-Bachs E., Grau E., Guil M., Guijarro R., Gutiérrez J., Hernández L., Hernández-Huerta S., Jara-Palomares L., Jaras M.J., Jiménez D., Lecumberri R., Lobo J.L., López-Jiménez L., López-Sáez J.B., Lorente M.A., Lorenzo A., Luque J.M., Madridano O., Macià M., Maestre A., Marchena P.J., Martín M., Martín-Villasclaras J.J., Monreal M., Mora J.M., Mosquera D., Muñoz F.J., Nauffal M.D., Nieto J.A., Núñez M.J., Ogea J.L., Otero R., Pedrajas J.M., Peris M.L., Riera-Mestre A., Rivas A., Rodríguez-Dávila M.A., Román P., Rosa V., Ruiz J., Ruiz-Gamietea A., Ruiz-Giménez N., Sahuquillo J.C., Samperiz A., Sánchez Muñoz-Torrero J.F., Soler S., Suriñach J.M., Tiberio G., Tilvan R.M., Tolosa C., Trujillo J., Uresandi F., Valdés M., Valero B., Valle R., Vela J., Vidal G., Vilar C., Villalobos A., Villalta J., Malý R., Hirmerova J., Miklo Sová M., Salgado E., Bertoletti L., Bura-Riviere A., Farge-Bancel D., Mahe I., Merah A., Quere I., Schellong S., Babalis D., Papadakis M., Tzinieris I., Braester A., Brenner B., Tzoran I., Zeltser D., Barillari G., Ciammaichella M., Di Micco P., Duce R., Maida R., Dalla Valle F., Piovella C., Poggio R., Prandoni P., Quintavalla R., Rota L., Schenone A., Tiraferri E., Tonello D., Tufano A., Visonà A., Zalunardo B., Fernandes M., Gonçalves F., Santos M., Saraiva M., Sousa R., Bosevski M., Kovacevic D., Alatri A., Aujeski D., Bounameaux H., Calanca L., Mazzolai L.
ISSN
2213-3348 (Electronic)
Publication state
Published
Issued date
04/2015
Volume
3
Number
2
Pages
135-41.e1
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
Patients with acute venous thromboembolism (VTE) are at increased risk for the development of subsequent arterial ischemic events unrelated to the diagnosis of VTE. Accurate identification of VTE patients at increased risk for ischemic events during the course of anticoagulation may help to select those who would potentially benefit from concomitant therapy with anticoagulants and antiplatelets.
We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry to assess the rate and severity of subsequent ischemic events (ie, stroke, myocardial infarction, lower limb amputation, or mesenteric ischemia) appearing during the course of anticoagulant therapy and tried to identify risk factors for these events.
From February 2009 to March 2014, 23,370 patients were recruited: 12,397 initially presenting with pulmonary embolism (PE) and 10,973 with deep venous thrombosis. During the course of anticoagulation (mean, 9.2 months), 597 patients developed recurrent VTE, 652 bled, 162 had ischemic events (stroke, 86; myocardial infarction, 53; limb amputation, 13; mesenteric ischemia, 11), and 2063 died. Of these, 29 patients died of recurrent PE, 83 of bleeding, and 53 of the ischemic events. On multivariable analysis, cancer (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.21-2.61), chronic lung disease (HR, 1.54; 95% CI, 1.05-2.26), renal insufficiency (HR, 1.72; 95% CI, 1.25-2.36), anemia (HR, 1.54; 95% CI, 1.11-2.14), prior artery disease (HR, 1.84; 95% CI, 1.29-2.64), and diabetes (HR, 1.58; 95% CI, 1.10-2.27) independently predicted the risk for ischemic events. Most of these variables also predicted major bleeding (cancer, chronic lung disease, renal insufficiency, anemia, and prior artery disease) or recurrent PE (cancer, chronic lung disease, anemia, and prior artery disease).
In patients receiving anticoagulation for VTE, the mortality due to PE recurrences was lower than the mortality due to ischemic events. Most independent predictors for ischemic events were also predictors for major bleeding and for recurrent PE.
We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry to assess the rate and severity of subsequent ischemic events (ie, stroke, myocardial infarction, lower limb amputation, or mesenteric ischemia) appearing during the course of anticoagulant therapy and tried to identify risk factors for these events.
From February 2009 to March 2014, 23,370 patients were recruited: 12,397 initially presenting with pulmonary embolism (PE) and 10,973 with deep venous thrombosis. During the course of anticoagulation (mean, 9.2 months), 597 patients developed recurrent VTE, 652 bled, 162 had ischemic events (stroke, 86; myocardial infarction, 53; limb amputation, 13; mesenteric ischemia, 11), and 2063 died. Of these, 29 patients died of recurrent PE, 83 of bleeding, and 53 of the ischemic events. On multivariable analysis, cancer (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.21-2.61), chronic lung disease (HR, 1.54; 95% CI, 1.05-2.26), renal insufficiency (HR, 1.72; 95% CI, 1.25-2.36), anemia (HR, 1.54; 95% CI, 1.11-2.14), prior artery disease (HR, 1.84; 95% CI, 1.29-2.64), and diabetes (HR, 1.58; 95% CI, 1.10-2.27) independently predicted the risk for ischemic events. Most of these variables also predicted major bleeding (cancer, chronic lung disease, renal insufficiency, anemia, and prior artery disease) or recurrent PE (cancer, chronic lung disease, anemia, and prior artery disease).
In patients receiving anticoagulation for VTE, the mortality due to PE recurrences was lower than the mortality due to ischemic events. Most independent predictors for ischemic events were also predictors for major bleeding and for recurrent PE.
Pubmed
Create date
14/02/2017 12:56
Last modification date
20/08/2019 17:22
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