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Background: The duration of anticoagulation for a first episode of unprovoked venous thromboembolism (VTE) should balance the likelihood of VTE recurrence against the risk of major bleeding. Objectives: Analyze rates and case-fatality rates (CFRs) of recurrent VTE and major bleeding after discontinuing anticoagulation in patients with a first unprovoked VTE after at least 3 months of anticoagulation. Methods: We compared the rates and CFRs in patients of the Registro Informatizado Enfermedad Trombo Embólica (RIETE) and Contemporary management and outcomes in patients with venous thromboembolism registries. We used logistic regression models to identify predictors for recurrent pulmonary embolism (PE) and major bleeding. Results: Of 8261 patients with unprovoked VTE in RIETE registry, 4012 (48.6%) had isolated deep vein thrombosis (DVT) and 4250 had PE. Follow-up (median, 318 days) showed 543 recurrent DVTs, 540 recurrent PEs, 71 major bleeding episodes, and 447 deaths. The Contemporary management and outcomes in patients with venous thromboembolism registry yielded similar results. Corresponding CFRs of recurrent DVT, PE, and major bleeding were 0.4%, 4.6%, and 24%, respectively. On multivariable analyses, initial PE presentation (hazard ratio [HR], 3.03; 95% CI, 2.49-3.69), dementia (HR, 1.47; 95% CI, 1.01-2.13), and anemia (HR, 0.72; 95% CI, 0.57-0.91) predicted recurrent PE, whereas older age (HR, 2.11; 95% CI, 1.15-3.87), inflammatory bowel disease (HR, 4.39; 95% CI, 1.00-19.3), and anemia (HR, 2.24; 95% CI, 1.35-3.73) predicted major bleeding. Prognostic scores were formulated, with C statistics of 0.63 for recurrent PE and 0.69 for major bleeding. Conclusion: Recurrent DVT and PE were frequent but had low CFRs (0.4% and 4.6%, respectively) after discontinuing anticoagulation. On the contrary, major bleeding was rare but had high CFR (24%). A few clinical factors may predict these outcomes.
Clinical outcomes after discontinuing anticoagulant therapy in patients with first unprovoked venous thromboembolism / C., Gabara; J., Aibar; Y., Nishimoto; Y., Yamashita; P., Prandoni; G. D., Barnes; B., Bikdeli; D., Jiménez; P., Demelo-Rodríguez; M. L., Peris; S. T., Nguyen; M., Monreal; Agudo, P; Aibar, J; Alberich-Conesa, A; Alda-Lozano, A; Alfonso, J; Amado, C; Angelina-García, M; I Arcelus, J; Ballaz, A; Barba, R; Barbagelata, C; Barreiro, B; Barrón, M; Barrón-Andrés, B; Bascuñana, J; Beddar-Chaib, F; Blanco-Molina, A; C Caballero, J; Cañas, I; Castellanos, G; Chasco, L; Claver, G; Criado, J; De Juana-Izquierdo, C; Del Toro, J; Demelo-Rodríguez, P; C Díaz-Pedroche, M; A Díaz-Peromingo, J; Dubois-Silva, A; C Escribano, J; Falgá, C; Fernández-Aracil, C; Fernández-Capitán, C; Fernández-Jiménez, B; L Fernández-Reyes, J; A Fidalgo, M; Francisco, I; Gabara, C; Galeano-Valle, F; García-Bragado, F; García-Ortega, A; Gavín-Sebastián, O; Gil-Díaz, A; Gómez-Cuervo, C; González-Munera, A; Grau, E; Guirado, L; Gutiérrez-Guisado, J; Hernández-Blasco, L; Hernández-Molina, A; J Hernández-Vidal, M; Jara-Palomares, L; Jiménez, D; Jou, I; D Joya, M; Lalueza, A; Lecumberri, R; Llamas, P; L Lobo, J; López-Brull, H; López-De la Fuente, M; López-Jiménez, L; López-Miguel, P; J López-Núñez, J; López-Ruiz, A; B López-Sáez, J; A Lorente, M; Lorenzo, A; Lumbierres, M; Madridano, O; Maestre, A; J Marchena, P; Marcos, M; Martín Del Pozo, M; Martín-Martos, F; Martínez-Prado, R; M Maza, J; I Mercado, M; Moisés, J; Molino, A; Monreal, M; Monzón, L; V Morales, M; Muñoz-Gamito, G; S Navas, M; A Nieto, J; J Núñez-Fernández, M; Olid, M; Ordieres-Ortega, L; Ortiz, M; Osorio, J; Otálora, S; Otero, R; Pacheco-Gómez, N; Pagán, J; C Palomeque, A; Paredes, E; Parra-Rosado, P; M Pedrajas, J; Pérez-Ductor, C; Pérez-Pinar, M; L Peris, M; L Pesce, M; A Porras, J; Puchades, R; Rivas, A; Rivera-Cívico, F; Rivera-Gallego, A; Rodríguez-Cobo, A; Romero-Bruguera, M; Ruiz-Artacho, P; Salgueiro, G; Sancho, T; Sendín, V; Sigüenza, P; Soler, S; Steinherr, A; Suárez-Fernández, S; Tirado, R; Torrents-Vilar, A; I Torres, M; Trujillo-Santos, J; Uresandi, F; Valle, R; F Varona, J; Villalobos, A; Villares, P; Ay, C; Nopp, S; Pabinger, I; Vanassche, T; Verhamme, P; Verstraete, A; B Yoo, H H; C Montenegro, A; N Morales, S; Roa, J; Hirmerova, J; Malý, R; Varhaník, F; Bertoletti, L; Bura-Riviere, A; Catella, J; Chopard, R; Couturaud, F; Espitia, O; Le Mao, R; Leclerq, B; Mahé, I; Moustafa, F; Plaisance, L; Sarlon-Bartoli, G; Suchon, P; Versini, E; Schellong, S; Brenner, B; Dally, N; Kenet, G; Tzoran, I; Rashidi, F; Sadeghipour, P; Tahmasbi, F; Abenante, A; Barillari, G; Bilora, F; Bissacco, D; Brandolin, B; Casana, R; Ciammaichella, M; Colaizzo, D; Dentali, F; Di Micco, P; Giorgi-Pierfranceschi, M; Grandone, E; Imbalzano, E; Lambertenghi-Deliliers, D; Martini, R; Meschi, T; Negro, F; Poz, A; Prandoni, P; Simioni, P; Siniscalchi, C; Taflaj, B; Ticinesi, A; Tufano, A; Visonà, A; Zalunardo, B; Kalnina, P; Kigitovica, D; Skride, A; Zicans, M; Nishimoto, Y; Yamashita, Y; Tazi-Mezalek, Z; Fonseca, S; Marques, R; Meireles, J; Pinto, S; Bosevski, M; Zdraveska, M; Bounameaux, H; Mazzolai, L; Aujayeb, A; Bikdeli, B; A Caprini, J; Khalil, A; Tafur, J; Weinberg, I; M Bui, H; T Nguyen, S; Q Pham, K; B Tran, G. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 22:8(2024), pp. 2234-2246. [10.1016/j.jtha.2024.05.007]
Clinical outcomes after discontinuing anticoagulant therapy in patients with first unprovoked venous thromboembolism
Gabara C.;Aibar J.;Nishimoto Y.;Yamashita Y.;Prandoni P.;Barnes G. D.;Bikdeli B.;Jiménez D.;Demelo-Rodríguez P.;Peris M. L.;Nguyen S. T.;Monreal M.;P Agudo;J Aibar;A Alberich-Conesa;A Alda-Lozano;J Alfonso;C Amado;M Angelina-García;J I Arcelus;A Ballaz;R Barba;C Barbagelata;B Barreiro;M Barrón;B Barrón-Andrés;J Bascuñana;F Beddar-Chaib;A Blanco-Molina;J C Caballero;I Cañas;G Castellanos;L Chasco;G Claver;J Criado;C De Juana-Izquierdo;J Del Toro;P Demelo-Rodríguez;M C Díaz-Pedroche;J A Díaz-Peromingo;A Dubois-Silva;J C Escribano;C Falgá;C Fernández-Aracil;C Fernández-Capitán;B Fernández-Jiménez;J L Fernández-Reyes;M A Fidalgo;I Francisco;C Gabara;F Galeano-Valle;F García-Bragado;A García-Ortega;O Gavín-Sebastián;A Gil-Díaz;C Gómez-Cuervo;A González-Munera;E Grau;L Guirado;J Gutiérrez-Guisado;L Hernández-Blasco;A Hernández-Molina;M J Hernández-Vidal;L Jara-Palomares;D Jiménez;I Jou;M D Joya;A Lalueza;R Lecumberri;P Llamas;J L Lobo;H López-Brull;M López-De la Fuente;L López-Jiménez;P López-Miguel;J J López-Núñez;A López-Ruiz;J B López-Sáez;M A Lorente;A Lorenzo;M Lumbierres;O Madridano;A Maestre;P J Marchena;M Marcos;M Martín Del Pozo;F Martín-Martos;R Martínez-Prado;J M Maza;M I Mercado;J Moisés;A Molino;M Monreal;L Monzón;M V Morales;G Muñoz-Gamito;M S Navas;J A Nieto;M J Núñez-Fernández;M Olid;L Ordieres-Ortega;M Ortiz;J Osorio;S Otálora;R Otero;N Pacheco-Gómez;J Pagán;A C Palomeque;E Paredes;P Parra-Rosado;J M Pedrajas;C Pérez-Ductor;M Pérez-Pinar;M L Peris;M L Pesce;J A Porras;R Puchades;A Rivas;F Rivera-Cívico;A Rivera-Gallego;A Rodríguez-Cobo;M Romero-Bruguera;P Ruiz-Artacho;G Salgueiro;T Sancho;V Sendín;P Sigüenza;S Soler;A Steinherr;S Suárez-Fernández;R Tirado;A Torrents-Vilar;M I Torres;J Trujillo-Santos;F Uresandi;R Valle;J F Varona;A Villalobos;P Villares;C Ay;S Nopp;I Pabinger;T Vanassche;P Verhamme;A Verstraete;H H B Yoo;A C Montenegro;S N Morales;J Roa;J Hirmerova;R Malý;F Varhaník;L Bertoletti;A Bura-Riviere;J Catella;R Chopard;F Couturaud;O Espitia;R Le Mao;B Leclerq;I Mahé;F Moustafa;L Plaisance;G Sarlon-Bartoli;P Suchon;E Versini;S Schellong;B Brenner;N Dally;G Kenet;I Tzoran;F Rashidi;P Sadeghipour;F Tahmasbi;A Abenante;G Barillari;F Bilora;D Bissacco;B Brandolin;R Casana;M Ciammaichella;D Colaizzo;F Dentali;P Di Micco;M Giorgi-Pierfranceschi;E Grandone;E Imbalzano;D Lambertenghi-Deliliers;R Martini;T Meschi;F Negro;A Poz;P Prandoni;P Simioni;C Siniscalchi;B Taflaj;A Ticinesi;A Tufano;A Visonà;B Zalunardo;P Kalnina;D Kigitovica;A Skride;M Zicans;Y Nishimoto;Y Yamashita;Z Tazi-Mezalek;S Fonseca;R Marques;J Meireles;S Pinto;M Bosevski;M Zdraveska;H Bounameaux;L Mazzolai;A Aujayeb;B Bikdeli;J A Caprini;A Khalil;J Tafur;I Weinberg;H M Bui;S T Nguyen;K Q Pham;G B Tran
2024-01-01
Abstract
Background: The duration of anticoagulation for a first episode of unprovoked venous thromboembolism (VTE) should balance the likelihood of VTE recurrence against the risk of major bleeding. Objectives: Analyze rates and case-fatality rates (CFRs) of recurrent VTE and major bleeding after discontinuing anticoagulation in patients with a first unprovoked VTE after at least 3 months of anticoagulation. Methods: We compared the rates and CFRs in patients of the Registro Informatizado Enfermedad Trombo Embólica (RIETE) and Contemporary management and outcomes in patients with venous thromboembolism registries. We used logistic regression models to identify predictors for recurrent pulmonary embolism (PE) and major bleeding. Results: Of 8261 patients with unprovoked VTE in RIETE registry, 4012 (48.6%) had isolated deep vein thrombosis (DVT) and 4250 had PE. Follow-up (median, 318 days) showed 543 recurrent DVTs, 540 recurrent PEs, 71 major bleeding episodes, and 447 deaths. The Contemporary management and outcomes in patients with venous thromboembolism registry yielded similar results. Corresponding CFRs of recurrent DVT, PE, and major bleeding were 0.4%, 4.6%, and 24%, respectively. On multivariable analyses, initial PE presentation (hazard ratio [HR], 3.03; 95% CI, 2.49-3.69), dementia (HR, 1.47; 95% CI, 1.01-2.13), and anemia (HR, 0.72; 95% CI, 0.57-0.91) predicted recurrent PE, whereas older age (HR, 2.11; 95% CI, 1.15-3.87), inflammatory bowel disease (HR, 4.39; 95% CI, 1.00-19.3), and anemia (HR, 2.24; 95% CI, 1.35-3.73) predicted major bleeding. Prognostic scores were formulated, with C statistics of 0.63 for recurrent PE and 0.69 for major bleeding. Conclusion: Recurrent DVT and PE were frequent but had low CFRs (0.4% and 4.6%, respectively) after discontinuing anticoagulation. On the contrary, major bleeding was rare but had high CFR (24%). A few clinical factors may predict these outcomes.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/3002513
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
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