Abstract
Background and Objectives: The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Materials and Methods: We used data from the RIETE (Registro Enfermedad TromboEmbólica) registry to compare mortality, VTE recurrence, and major bleeding risk in smoking versus non-smoking patients with acute VTE. Results: 50,881 patients (43,426 non-smoking and 7455 smoking patients) were included. After a median follow-up of 8.8 months, 7110 patients died (fatal PE 292 and fatal bleeding 281), 3243 presented VTE recurrence, and 1579 had major bleeding. At multivariate analysis, smoking behavior was associated with a higher hazard of death, (HR: 1.28; 95% CI: 1.19–1.40). The risk of VTE recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI: 1.02–1.27). Major bleeding did not differ in smoking and non-smoking patients (1.15; 95% CI: 0.96–1.38). The presence of cancer did not appear to influence the association between smoking habits and death (HR: 1.34; 95% CI: 1.22–1.47 in cancer patients and HR: 1.23; 95% CI: 1.04, 1.45 in non-cancer patients, respectively) Conclusions: the risk of death after an acute episode of VTE appeared to be higher in smoking than in non-smoking patients and this risk is higher between patients presenting PE at the onset of symptoms.
Highlights
Venous thromboembolism is one of most frequent cardiovascular diseases associated with death and it is considered as a major health problem because cardiovascular diseases (CVD) are the leading cause of mortality in the general population [1].Cigarette smoking (CS) may be considered a major risk factor for atherothrombosis [e.g., acute coronary syndrome (ACS), ischaemic stroke (IS), and peripheral arterial disease (PAD)] [2,3] and for pulmonary embolism, according to a meta-analysis of a large cohort of smokers [4]; consistent data suggest that CS is associated with a worse survival and event-free survival in these patients [5]
Risk of venous thromboembolism (VTE) recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI 1.02–1.27)
CS is associated with a worse survival and event-free survival in patients presenting with arterial cardiovascular events [4]
Summary
Venous thromboembolism is one of most frequent cardiovascular diseases associated with death and it is considered as a major health problem because cardiovascular diseases (CVD) are the leading cause of mortality in the general population [1].Cigarette smoking (CS) may be considered a major risk factor for atherothrombosis [e.g., acute coronary syndrome (ACS), ischaemic stroke (IS), and peripheral arterial disease (PAD)] [2,3] and for pulmonary embolism, according to a meta-analysis of a large cohort of smokers [4]; consistent data suggest that CS is associated with a worse survival and event-free survival in these patients [5]. CS has been frequently associated as risk factor for the morbidity and mortality of patients affected by venous thromboembolism (VTE), data in the literature are less compelling [6,7]. The influence of smoking habits during anticoagulation for a VTE is really complex to understand and its effect on mortality, VTE recurrence, and major bleeding has not been consistently evaluated after a VTE. The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE). Enfermedad TromboEmbólica) registry to compare mortality, VTE recurrence, and major bleeding risk in smoking versus non-smoking patients with acute VTE. The risk of VTE recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI 1.02–1.27). The presence of cancer did not appear to influence the association between smoking habits and death (HR 1.34; 95% CI 1.22–1.47 in cancer patients and HR 1.23; 95% CI 1.04, 1.45 in non-cancer patients, respectively) Conclusions: the risk of death after an acute episode of VTE appeared to be higher in smoking than in non-smoking patients and this risk is higher between patients presenting PE at the onset of symptoms
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