Causes of death in an unselected population with first time venous thromboembolism

Abstract

Abstract Background and aim Causes of death in an unselected population with first-time community acquired venous thromboembolism (VTE) is largely unknown in the contemporary era of direct oral anticoagulation (DOAC). Material and methods All patients >18 years of age who had a visit for any medical reason to any of 5 different emergency departments (EDs) in our city from 1st January 2016 to 31st December 2017 were included. We identified all patients with any incident VTE (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)) at the time of the ED visit. 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 any VTE, using all other ED 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 median 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 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 patients (HR 4.6; 95% CI, 4.1–5.1 respectively), compared to the referent. A diagnosis of PE at the ED visit was associated with a 50% increased risk of cardiovascular death (HR 1.5; 95% CI, 1.2–1.9). Conclusion Patients with VTE have a high risk of all-cause mortality, including non-cancer related death and cardiovascular death despite improvements of diagnosis and treatment with DOAC. The study findings indicate that further improvement is needed in VTE management. Funding Acknowledgement Type of funding sources: None.