Long-Term Survival in a Large Cohort of Patients with Venous Thrombosis: Incidence and Predictors

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Background:
Venous thrombosis is a common disease with a high mortality rate shortly after the event. However, details on long-term mortality in these patients are lacking. The aim of this study was to determine long-term mortality in a large cohort of patients with venous thrombosis.

Methods and Findings:
4,947 patients from the Multiple Environmental and Genetic Assessment study of risk factors for venous thrombosis (MEGA study) with a first nonfatal venous thrombosis or pulmonary embolism and 6,154 control individuals without venous thrombosis, aged 18 to 70 years, were followed up for 8 years. Death and causes of death were retrieved from the Dutch death registration. Standardized mortality ratios (SMRs) were calculated for patients compared with control individuals. Several subgroups were studied as well.

736 participants (601 patients and 135 controls) died over a follow-up of 54,948 person-years. The overall mortality rate was 22.7 per 1,000 person-years (95% CI 21.0–24.6) for patients and 4.7 per 1,000 person-years (95% CI 4.0–5.6) for controls. Patients with venous thrombosis had a 4.0-fold (95% CI 3.7–4.3) increased risk of death compared with controls. The risk remained increased up to 8 years after the thrombotic event, even when no additional comorbidities were present. The highest risk of death was found for patients with additional malignancies (SMR 5.5, 95% CI 5.0–6.1). Main causes of death were diseases of the circulatory system, venous thrombosis, and malignancies. Main limitation was a maximum age of 70 at time of inclusion for the first event. Therefore results can not be generalized to those in the highest age categories.

Conclusions:
Patients who experienced a first venous thrombosis had an increased risk of death which lasted up to 8 years after the event, even when no comorbidities were present at time of thrombosis. Future long-term clinical follow-up could be beneficial in these patients.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Long-Term Survival in a Large Cohort of Patients with Venous Thrombosis: Incidence and Predictors. PLoS Med 9(1): e32767. doi:10.1371/journal.pmed.1001155
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001155

Souhrn

Zdroje

1. OgerE 2000 Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 83 657 660

2. NaessIAChristiansenSCRomundstadPCannegieterSCRosendaalFR 2007 Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 5 692 699

3. RosendaalFR 1999 Venous thrombosis: a multicausal disease. Lancet 353 1167 1173

4. HeitJAMohrDNSilversteinMDPettersonTMO'FallonWM 2000 Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 160 761 768

5. KyrlePAMinarEBialonczykCHirschlMWeltermannA 2004 The risk of recurrent venous thromboembolism in men and women. N Engl J Med 350 2558 2563

6. BaglinTLuddingtonRBrownKBaglinC 2003 Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 362 523 526

7. KahnSR 2006 The post-thrombotic syndrome: the forgotten morbidity of deep venous thrombosis. J Thromb Thrombolysis 21 41 48

8. BeythRJCohenAMLandefeldCS 1995 Long-term outcomes of deep-vein thrombosis. Arch Intern Med 155 1031 1037

9. HeitJASilversteinMDMohrDNPettersonTMO'FallonWM 1999 Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med 159 445 453

10. GoldhaberSZVisaniLDe RosaM 1999 Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353 1386 1389

11. LaporteSMismettiPDecoususHUresandiFOteroR 2008 Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 117 1711 1716

12. BlomJWDoggenCJMOsantoSRosendaalFR 2005 Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293 715 722

13. BezemerIDBareLADoggenCJMArellanoARTongC 2008 Gene variants associated with deep vein thrombosis. JAMA 299 1306 1314

14. WHO 2009 International Statistical Classificaton of Diseases and Related Health Problems. 10th version (ICD-10) Geneva WHO

15. 2007 Doodsoorzakenstatistiek CBS Nederland The Hague Centraal Bureau voor de Statistiek

16. ReitterSEWaldhoerTMayerhoferMEigenbauerEAyC 2011 Long-term survival of patients with a history of venous thromboembolism. Ann Hematol 90 585 594

17. SørensenHTMellemkjærLOlsenJHBaronJA 2000 Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343 1846 1850

18. GrossCPGalushaDHKrumholzHM 2007 The impact of venous thromboembolism on risk of death or hemorrhage in older cancer patients. J Gen Intern Med 22 321 326

19. PrandoniP 2007 Links between arterial and venous disease. J Intern Med 262 341 350

20. BovaCMarchioriANotoARossiVDanieleF 2006 Incidence of arterial cardiovascular events in patients with idiopathic venous thromboembolism. A retrospective cohort study. Thromb Haemost 96 132 136

21. FranchiniMMannucciPM 2008 Venous and arterial thrombosis: different sides of the same coin? Eur J Intern Med 19 476 481