scholarly journals Different Types of Statins and All-Cause Mortality during Anticoagulation for Venous Thromboembolism: Validation Study from RIETE Registry

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e236-e244
Author(s):  
Carmine Siniscalchi ◽  
José M. Suriñach ◽  
Adriana Visonà ◽  
José L. Fernández-Reyes ◽  
Covadonga Gómez-Cuervo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Lower Risk ◽  
Multivariable Analysis ◽  
Fatal Pulmonary Embolism ◽  
Risk Of Death ◽  
Fatal Bleeding ◽  
All Cause Mortality ◽  
Different Types

Abstract Introduction We previously reported that during the course of anticoagulation for venous thromboembolism (VTE) patients using statins were at a lower risk to die than nonusers. Methods We used the Registro Informatizado Enfermedad TromboEmbólica (RIETE) registry to validate our previous findings in a subsequent cohort of patients and to compare the risk of death according to the use of different types of statins. Results From January 2018 to December 2019, 19,557 patients with VTE were recruited in RIETE. Of them, 4,065 (21%) were using statins (simvastatin, 1,406; atorvastatin, 1,328; rosuvastatin, 246; and others, 1,085). During anticoagulation (192 vs.182 days, for statin and no statin users respectively), 500 patients developed a VTE recurrence, 519 suffered major bleeding, and 1,632 died (fatal pulmonary embolism [PE], 88 and fatal bleeding, 78). On multivariable analysis, statin users were at a lower risk to die (hazard ratio [HR] = 0.68; 95% confidence interval [CI]: 0.59–0.79) than nonusers. When separately analyzing the drugs, on multivariable analysis, patients using simvastatin (HR = 0.64; 95% CI: 0.52–0.80), atorvastatin (HR 0.72; 95% CI: 0.58–0.89), or other statins (HR = 0.67; 95% CI: 0.52–0.87) were at a lower risk to die than nonusers. For those using rosuvastatin, difference was not statistically significant (HR = 0.77; 95% CI: 0.50–1.19), maybe due to the sample size. Conclusion Our data validate previous findings and confirm that VTE patients using statins at baseline are at a lower risk to die than nonusers. No statistically differences were found according to type of statins.

Incidence and predictors of venous thromboembolism in post-acute care patients

2010 ◽  
Vol 104 (10) ◽  
pp. 734-740 ◽  
Author(s):  
Walter Ageno ◽  
Andrea Airoldi ◽  
Erminio Bonizzoni ◽  
Mauro Campanini ◽  
Gualberto Gussoni ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Term Care ◽  
Risk Of Death ◽  
Increased Risk ◽  
Rehabilitation Facilities ◽  
Overall Mortality

SummaryFew studies have addressed the topic of venous thromboembolism (VTE) in patients hospitalised in rehabilitation facilities. This patient population is rapidly growing, and data aimed to better define VTE risk in this setting are needed. Primary aim of this prospective observational study was to evaluate the frequency of symptomatic, objectively confirmed VTE in a cohort of unselected consecutive patients admitted to rehabilitation facilities, after medical diseases or surgery. Further objectives were to assess overall mortality, to identify risk factors for VTE and mortality, and to assess the attitude of physicians towards thromboprophylaxis. A total of 3,039 patients were included in the study, and the median duration of hospitalisation was 26 days. Seventy-two patients (2.4%) had symptomatic VTE. The median time to VTE from admission to the long-term care unit was 13 days. According to multivariable analysis, previous VTE (hazard ratio 5.67, 95% confidence interval 3.30–9.77) and cancer (hazard ratio 2.26, 95% confidence interval 1.36–3.75) were significantly associated to the occurrence of VTE. Overall in-hospital mortality was 15.1%. Age over 75 years, male gender, disability, cancer, and the absence of thromboprophylaxis were significantly associated to an increased risk of death (multivariable analysis). In-hospital antithrombotic prophylaxis was administered to 75.1% of patients, and low-molecular-weight heparin was the most widely used agent. According to our study, patients admitted to rehabilitation facilities remain at substantially increased risk for VTE. Because this applies to the majority of these patients, there is a great need for clinical trials assessing optimal prophylactic strategies.

scholarly journals Association between obstructive sleep apnea and venous thromboembolism recurrence: results from a French cohort

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Olivier Nepveu ◽  
Charles Orione ◽  
Cécile Tromeur ◽  
Alexandre Fauché ◽  
Cecile L’heveder ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Venous Thromboembolism ◽  
Sleep Apnea ◽  
Multivariable Analysis ◽  
Recurrence Risk ◽  
Vein Thrombosis ◽  
Risk Of Death ◽  
Obstructive Sleep ◽  
All Cause Mortality ◽  
Recurrent Vte

Abstract Background Growing evidence suggests the relationship between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Few studies focused on VTE recurrence risk associated with OSA after anticoagulation cessation. Methods In a prospective cohort study, patients with documented VTE, were followed for an indefinite length of time and VTE recurrence were documented and adjudicated. The primary outcome was recurrent VTE after anticoagulation discontinuation. Secondary outcomes included all-cause mortality and the clinical presentation of VTE. Univariable and multivariable analyses were performed to identify risk factors for recurrence and mortality. Results Among the 2109 patients with documented VTE included, 74 patients had moderate to severe OSA diagnosis confirmed by home sleep test or polysomnography. During a median follow-up of 4.8 (interquartile range 2.5–8.0) years recurrent VTE occurred in 252 patients (9 with OSA and 243 without OSA). The recurrence risk in the univariable and multivariable analysis was not increased in patients with OSA, regardless of the time of diagnosis (before or after index VTE or pooled). VTE phenotype was significantly more often PE with or without associated deep vein thrombosis in the first event and recurrence for OSA patients compared to non-OSA patients. The risk of death was not increased in the OSA population compared to non-OSA patients in multivariable analysis. Conclusions In patients with OSA and VTE, the risk of all-cause mortality and VTE recurrence after anticoagulation discontinuation was not increased compared to non-OSA patients.

Venous Thromboembolism in Patients With Autoimmune Disorders: Findings From the RIETE Registry

Angiology ◽  
2019 ◽  
Vol 71 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Pablo Ruiz Sada ◽  
Juan J. López-Núñez ◽  
Angel Samperiz ◽  
María José Soto ◽  
José María Pedrajas ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Major Bleeding ◽  
Lower Risk ◽  
Multivariable Analysis ◽  
Autoimmune Disorders ◽  
Increased Risk ◽  
Similar Risk

Patients with autoimmune disorders are at an increased risk of venous thromboembolism (VTE), but this association has not been consistently evaluated. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to compare the rates of VTE recurrences, major bleeding, and death during the course of anticoagulation, according to the presence or absence of autoimmune disorders. Of 71 625 patients with VTE recruited in February 2018, 1800 (2.5%) had autoimmune disorders. Median duration of anticoagulant therapy was slightly longer in patients with autoimmune disorders (median, 190 vs 182 days; P = .001). On multivariable analysis, patients with autoimmune disorders had a similar risk of VTE recurrences (hazard ratio [HR]: 0.93; 95% confidence interval [CI]: 0.68-1.27) or major bleeding (HR: 1.07; 95% CI: 0.82-1.40) and a lower risk to die (HR: 0.66; 95% CI: 0.54-0.81) than those without autoimmune disorders. Patients with giant cell arteritis had the highest rates of major bleeding (8.6 events per 100 patient-years) and the lowest rate of recurrences (zero). In other subgroups, the rates of both events were more balanced. During anticoagulation, patients with or without autoimmune disorders had similar rates of VTE recurrences or major bleeding. However, there were some differences between subgroups of patients with autoimmune disorders.

Psychotropic Drugs and Outcome in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism

2020 ◽  
Vol 120 (04) ◽  
pp. 620-626
Author(s):  
Pablo Javier Marchena ◽  
Inna Tzoran ◽  
Benjamin Brenner ◽  
Mar Martín ◽  
Radovan Malý ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Psychotropic Drugs ◽  
Multivariable Analysis ◽  
Intracranial Bleeding ◽  
Fatal Pulmonary Embolism ◽  
Fatal Bleeding ◽  
Increased Risk ◽  
Similar Risk

Abstract Background The influence (if any) of the use of psychotropic drugs on outcome in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Methods We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the risk for VTE recurrences, major bleeding, or death during the course of anticoagulant therapy, according to the use of psychotropics at baseline. Results Among 49,007 patients with VTE enrolled from February 2009 to September 2019, total 5,230 (11%) were using psychotropics at baseline: antidepressants 3,273 (6.7%), antipsychotics 1,588 (3.2%), and anticholinesterases 369 (0.7%). During the course of anticoagulation, 1,259 patients developed VTE recurrences, 1,231 bled, and 3,988 died (fatal pulmonary embolism 269 and fatal bleeding 187). On multivariable analysis, patients using psychotropics at baseline had a similar risk for VTE recurrences (adjusted hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.58–1.12), a nonsignificantly higher risk for major bleeding (adjusted HR: 1.15; 95% CI: 0.97–1.35), and a higher risk for intracranial bleeding (adjusted HR: 1.83; 95% CI: 1.32–2.53) or death (adjusted HR: 1.44; 95% CI: 1.32–1.57) compared with those not using psychotropics. When separately analyzed, the highest risk for intracranial bleeding was found in patients using antidepressants (adjusted HR: 1.60; 95% CI: 1.08–2.37) or antipsychotics (adjusted HR: 2.02; 95% CI: 1.17–3.49) but not in those on anticholinesterases (adjusted HR: 1.69; 95% CI: 0.62–4.60). Conclusion During the course anticoagulation for VTE, patients using psychotropics at baseline were at increased risk for intracranial bleeding.

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

2020 ◽  
Author(s):  
David Spirk ◽  
Tim Sebastian ◽  
Stefano Barco ◽  
Martin Banyai ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Mortality Rate ◽  
Recurrence Rate ◽  
Anticoagulation Therapy ◽  
Early Mortality ◽  
Recurrence Rates ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer. Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not. Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

scholarly journals Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis

2021 ◽  
Author(s):  
Ping-Hsun Wu ◽  
Yi-Ting Lin ◽  
Jia-Sin Liu ◽  
Yi-Chun Tsai ◽  
Mei-Chuan Kuo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Cox Model ◽  
Major Adverse Cardiovascular Events ◽  
Maintenance Hemodialysis ◽  
Risk Of Death ◽  
Relative Safety ◽  
Dialysis Vintage ◽  
All Cause Mortality

Abstract Background Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients. Methods We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up. Results Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60–0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80–0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77–0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72–0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93–1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs. Conclusions Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.

Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dong Hoon Shin ◽  
Jaehun Jung ◽  
Gi Hwan Bae
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Antiplatelet Agents ◽  
Risk Of Death ◽  
Hemorrhagic Events ◽  
All Cause Mortality ◽  
Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

scholarly journals Adherence to the EAT-Lancet Healthy Reference Diet in relation to Coronary Heart Disease, All-Cause Mortality Risk and Environmental Impact: results from the EPIC-NL Cohort

2021 ◽  
Author(s):  
Chiara Colizzi ◽  
Marjolein C Harbers ◽  
Reina E Vellinga ◽  
WM Monique Verschuren ◽  
Jolanda MA Boer ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Environmental Impact ◽  
Confidence Interval ◽  
Water Use ◽  
Lower Risk ◽  
Blue Water ◽  
Marine Eutrophication ◽  
All Cause Mortality ◽  
High Adherence ◽  
Freshwater Eutrophication

Objectives: To construct a diet-score measuring the level of adherence to the Healthy Reference Diet (HRD), to explore whether adherence to the HRD is associated with coronary heart disease (CHD), all-cause mortality risk, and to calculate its environmental impact. Design: Prospective cohort study. Setting: The Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL). Participants: 37,349 adults (20-70y) without CHD at baseline. Main outcome measures: Primary outcomes were incident CHD and all-cause mortality. Secondary outcomes were greenhouse gas emission (GHGE), land use, blue water use, freshwater eutrophication, marine eutrophication, and terrestrial acidification. Results: During a median 15.3-year follow-up, 2,543 cases of CHD occurred, and 5,648 individuals died from all causes. The average HRD-score was 73 (SD=10). High adherence to the HRD was associated with a 15% lower risk of CHD (hazard ratio 0.85, 95% confidence interval 0.75 to 0.96), as well as a 17% lower risk of all-cause mortality (hazard ratio 0.83, 95% confidence interval 0.77 to 0.90) in multivariable-adjusted models. Better adherence to the HRD was associated with lower environmental impact from GHGE (β= -0.10 kg CO2-eq, 95% confidence interval -0.13 to -0.07), land use (β= -0.11 m2 per year, 95% confidence interval -0.12 to -0.09), freshwater eutrophication (β= -0.000002 kg P-eq, 95% confidence interval -0.000004 to -0.000001), marine eutrophication (β= -0.00035 kg N-eq, 95% confidence interval -0.00042 to -0.00029), and terrestrial acidification (β = -0.004 kg SO2-eq, 95% confidence interval -0.004 to -0.003), but with higher environmental impact from blue water use (β=0.044 m3, 95% confidence interval 0.043 to 0.045). Conclusion: High adherence to the HRD was associated with lower risk of CHD and all-cause mortality. Additionally, increasing adherence to the HRD could lower some aspects of the environmental impact of diets, but attention is needed for the associated increase in blue water use.

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