International Journal of General Medicine (Sep 2022)

Incidence and Predictors of Recurrence and Mortality Following First Venous Thromboembolism Among the Saudi Population: Single-Center Cohort Study

  • AlEidan FAS,
  • AlManea RK,
  • AlMoneef AT,
  • Shalash NA,
  • AlRajhi NA,
  • AlMousa SF,
  • Al Raizah A,
  • Abuelgasim KA

Journal volume & issue
Vol. Volume 15
pp. 7559 – 7568

Abstract

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Fahad A S AlEidan,1,2 Reem K AlManea,2 Alyah T AlMoneef,2 Nada A Shalash,2 Norah A AlRajhi,2 Sarah F AlMousa,2 Abdulrahman Al Raizah,1– 3 Khadega A Abuelgasim1,2 1King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 2College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Saudi Society for Bone Marrow Transplant, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Fahad A S AlEidan, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Tel +966118011111, Email [email protected]: Little is written about recurrence and mortality rates after a first episode of venous thromboembolism (VTE) among Saudi population.Aim: Determine incidence rates and assess predictors of recurrence and mortality following the first VTE event.Patients and Methods: A total of 1124 patients aged ≥ 18 years with symptomatic VTE confirmed by imaging tests were evaluated. The incidence of VTE recurrence and mortality were assessed. The association between patient characteristics, and VTE recurrence and mortality was explored by estimating the hazard ratio (HR) and 95% confidence interval (CI). The difference between cancer-related, provoked and unprovoked VTE in terms of recurrence and mortality was explored using Kaplan–Meier curves.Results: The annual incidence rate of the first VTE was 1.7 per 1000 patients. Of 1124 patients with first VTE, 214 (19%) developed recurrent VTE, and 192 (17%) died with overall incidence rates of 15.8 per 100 person-years (95% CI, 13.8– 18.0) and 10.0 per 100 person-years (95% CI, 8.7– 11.5). Intensive care unit (ICU) admission (HR, 2.15; 95% CI, 1.67– 3.10), presence of active cancer (HR, 2.97; 95% CI, 1.87– 3.95), immobilization (HR, 2.52; 95% CI, 1.79– 3.67), infection (HR, 2.32; 95% CI, 1.94– 3.45), and pulmonary embolism ± deep venous thrombosis (HR, 2.22; 95% CI, 1.56– 3.16) were found to be independent predictors of recurrent VTE. Recurrence carries a high hazard of mortality (HR, 5.21; 95% CI, 3.61– 7.51). The estimated median time to VTE recurrence was lower in cancer-related VTE (18.7 months) compared with provoked (29.0 months) and unprovoked VTE (28.4 months). The estimated survival median time was lower in cancer-related VTE (21.8 months) compared with provoked (30.5 months) and unprovoked VTE (29.8 months).Conclusion: Immobilization and presence of active cancer, infection, and PE ± DVT were significant predictors of recurrent VTE. Patients who developed recurrent VTE had a 5.2-fold higher hazard of mortality compared with patients with no VTE recurrence.Keywords: incidence, mortality, predictors, recurrent, venous thromboembolism, active cancer

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