Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: A 20-year cohort study

Abstract

Conclusion: Patients with venous thromboembolism (VTE) have an increased long-term risk of arterial cardiovascular events. Summary: There are conflicting data with respect to whether VTE is associated with an increased risk of arterial cardiovascular events. To help clarify discrepant studies in previous publications, the authors sought to investigate the risk of arterial cardiovascular events in patients with VTE. This was a 20-year population-based cohort study. Data were obtained from nationwide Danish medical databases. Patients with known cardiovascular disease were excluded from this study. The authors then assessed the risk of stroke and myocardial infarction (MI) in 25,199 patients with deep venous thrombosis (DVT), 16,925 patients with pulmonary embolism (PE), and 163,566 controls. In patients with DVT, the relative risks (95% confidence interval) were 1.6 (1.35-1.91) for MI and 2.19 (1.85-2.60) for stroke ≤1 year after the thrombotic event. Similarly, in patients ≤1 year after a PE, the relative risks were 2.60 (2.14-3.14) for MI and 2.93 (2.34–3.66) for stroke. During the next 20 years of follow-up, patients with VTE had 20% to 40% increased risk for arterial cardiovascular events. There was no difference in relative risk in patients with provoked vs unprovoked DVT and PE. Comment: The etiology for the apparent association of atherosclerotic events with VTE is unclear. With the exception of obesity, there is not consistent evidence that venous and atherosclerotic diseases share common risk factors. Perhaps a common prothrombotic mechanism, such as endothelial damage or inflammation, accounts for a potential shared etiology between VTE and arterial ischemia. There are, after all, other conditions such as hyperhomocysteinemia and antiphospholipid antibody syndrome that exemplify disorders that have both arterial and venous thromboembolic features.