Portal de Periódicos da CAPES

Subsequent arterial ischemic events in patients receiving anticoagulant therapy for venous thromboembolism

2015; Elsevier BV; Volume: 3; Issue: 2 Linguagem: Inglês

10.1016/j.jvsv.2014.11.002

2213-3348

Olga Madridano, J. del Toro, Alicia Lorenzo, Mar Martín, Jorge Gómez Cerezo, Luís Hernández, Paolo Prandoni, Manuel Monréal, Juan I. Arcelus, M. Arroyo, Aitor Ballaz, Raquel Barba, M. Barrón, B. Barrón‐Andrés, José Bascuñana, Pedro Bedate Díaz, Á. Blanco-Molina, Tulio Bueso, I. Casado, Fátima del Molino, J. del Toro, C. Falgá, Carmen Fernández‐Capitán, Carme Font, M.I. Fuentes, P. Gallego, F García‐Bragado, O. Gavín, Vicente Gómez, J. González, E. González-Bachs, E Grau, María J. Guil, Ricardo Guijarro, Javier Cuesta, L. Hernández, S. Hernández-Huerta, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Ramón Lecumberri, José Luís Lobo, Luciano López‐Jiménez, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, J.M. Luque, Olga Madridano, M. Macià, Ana M. Maestre, P.J. Marchena, M. Martín, Juan José Martín-Villasclaras, Manuel Monréal, Jacob M. Mora, Damien Mosquera, F.J. Muñoz, M.D. Nauffal, J. Aizpurua Nieto, M.J. Núñez, J.L. Ogea, Remedios Otero, José María Pedrajas, M.L. Peris, Antoni Riera‐Mestre, A. Rivas, M.A. Rodríguez‐Dávila, P. Román, V. Rosa, Jonathan J. Ruiz, A. Ruiz-Gamietea, N. Ruiz‐Giménez, Joan Carles Sahuquillo, A. Sampériz, Juan Francisco Sánchez Muñoz-Torrero, S. Soler, J.M. Suriñach, G. Tiberio, R.M. Tilvan, Carlos Tolosa, Javier Trujillo, Fernando Uresandi, M. Valdés, B. Valero, R. Valle, J. Vela, G. Vidal, Carlos Vilar, A. Villalobos, J Villalta, Radován Malý, Jana Hirmerová, Milan Sova, E. Salgado, Laurent Bertoletti, A. Bura-Rivière, Dominique Farge, Isabelle Mahé, A. Merah, I. Quéré, Sebastian Schellong, Dimitrios Babalis, Marios Papadakis, I. Tzinieris, Andrei Braester, Benjamin Brenner, Inna Tzoran, David Zeltser, Giovanni Barillari, Maurizio Ciammaichella, P. Di Micco, R. Duce, R. Maida, F. Dalla Valle, Chiara Piovella, Rosana Poggio, Paolo Prandoni, Roberto Quintavalla, L. Rota, Alessandro Schenone, Eros Tiraferri, D. Tonello, Antonella Tufano, A. Visonà, Beniamino Zalunardo, Merwyn Fernandes, Filipe Gonçalves, Mafalda Santos, M Saraiva, R. Sousa, Marijan Bosevski, Dragan Kovačević, Adriano Alatri, D. Aujeski, Henri Bounameaux, Luca Calanca, Lucia Mazzolai,

Blood Coagulation and Thrombosis Mechanisms

Objective 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. Methods 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. Results 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). Conclusions 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. 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.