Causes of death after first time venous thromboembolism

Abstract

Abstract Background: Causes of death after first time community-acquired venous thromboembolism (VTE) diagnosed in unselected patients at the emergency department (ED) was investigated. Material and Methods: The study consists of all patients>18 years of age who had a visit for any medical reason to any of 5 different ED in Stockholm County, Sweden from 1st January 2016 to 31st December 2017. We have identified all patients with a first registered incident VTE; deep vein thrombosis (DVT) and/or pulmonary embolism (PE) during the study period. Cox regression models were used to estimate hazards ratios (HR) with 95% confidence intervals (CIs) for all-cause mortality and cause-specific death in patients with DVT or PE using all other patients as the reference group. Results: In total, 409,971 patients had an ED visit during the study period of whom 2% were diagnosed with VTE (DVT= 4,817, PE= 3,147). During a mean follow up of 2.6 years, 1265 (16%) and 25,191 (6.3%) patients died within the VTE and reference group, respectively. The adjusted risk of all-cause mortality was nearly double in patients with DVT (HR 1.7; 95% CI, 1.5-1.8) and 3-fold in patients with PE (HR 2.8; 95% CI, 2.6-3.0). While the risk of cancer related death was nearly 3-fold in patient with DVT (HR 2.7; 95% CI, 2.4-3.1), and 5-fold in PE (HR 4.6; 95% CI, 4.1-5.1 respectively). A diagnosis of PE at the ED visit was associated with a 50% increased risk of cardiovascular death (HR 1.50; 95% CI, 1.2-1.9). Conclusion: Patients with VTE have a high risk of all-cause mortality including cardiovascular death. The study findings indicate that cardiovascular preventive measures have to be improved in patients with VTE.