Download PDF
Thromb Haemost 2011; 106(06): 1095-1102
DOI: 10.1160/TH11-07-0469
Blood Coagulation, Fibrinolysis, and Cellular Haemostasis
Schattauer GmbH

Venous thromboembolism in patients with symptomatic atherosclerosis

Gregory Piazza
1   Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Samuel Z. Goldhaber
1   Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Darleen M. Lessard
2   Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
,
Robert J. Goldberg
2   Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
,
Catherine Emery
2   Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
,
Frederick A. Spencer
3   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations Financial support: This study was supported by grant R01-HL70283 (PI: Spencer) from the National Heart, Lung, and Blood Institute. Dr. Piazza is supported by a Research Career Development Award (K12 HL083786) from the National Heart, Lung, and Blood Institute (NHLBI). Dr. Spencer is supported by a Career Investigator Award from the Ontario Heart and Stroke Association.
Further Information

Publication History

Received: 08 July 2011

Accepted after major revision: 23 September 2011

Publication Date:
27 November 2017 (online)

    Permissions and Reprints

Summary

Patients with atherosclerosis have an increased risk of venous thromboembolism (VTE). We studied patients in the population-based Worcester VTE Study of 1,822 consecutive patients with validated VTE to compare clinical characteristics, prophylaxis, treatment, and outcomes of VTE in patients with and without symptomatic atherosclerotic cardiovascular disease, defined as history of ischaemic heart disease, history of positive cardiac catheterisation, percutaneous coronary intervention, or coronary artery bypass graft surgery, or history of peripheral artery disease. Of the 1,818 patients with VTE, 473 (26%) had a history of symptomatic atherosclerosis. Patients with atherosclerosis were significantly older (mean age 71.9 years vs. 61.6 years) and were more likely to have immobility (57.2% vs. 46.7%), prior heart failure (36.9% vs. 10.7%), chronic lung disease (26.4% vs. 15.5%), cerebrovascular disease (18.1% vs. 9.8%), and chronic kidney disease (4.9% vs. 1.9%) (all p<0.001) compared with non-atherosclerosis patients. Thromboprophylaxis was omitted in more than one-third of atherosclerosis patients who had been hospitalised for non-VTE-related illness or had undergone major surgery within the three months prior to VTE. Patients with atherosclerosis were significantly more likely to suffer in-hospital major bleeding (7.6% vs. 3.8%, p=0.0008). In conclusion, patients with atherosclerosis and VTE are more likely to suffer a complicated hospital course. Despite a high frequency of comorbid conditions contributing to the risk of VTE, we observed a low rate of thromboprophylaxis in patients with symptomatic atherosclerosis.

Keywords

Atherosclerosis - deep-vein thrombosis - prophylaxis - pulmonary embolism - treatment - venous thromboembolism
 

  • References

  • 1 Ridker PM, Danielson E, Fonseca FA. et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359: 2195-2207.
    CrossrefPubMedGoogle Scholar
  • 2 Glynn RJ, Danielson E, Fonseca FA. et al. A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med 2009; 360: 1851-1861.
    CrossrefPubMedGoogle Scholar
  • 3 Piazza G, Fanikos J, Zayaruzny M. et al. Venous thromboembolic events in hospitalised medical patients. Thromb Haemost 2009; 102: 505-510.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Prandoni P, Bilora F, Marchiori A. et al. An association between atherosclerosis and venous thrombosis. N Engl J Med 2003; 348: 1435-1441.
    CrossrefPubMedGoogle Scholar
  • 5 Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis. Circulation 2010; 121: 2146-2150.
    CrossrefPubMedGoogle Scholar
  • 6 Ageno W, Becattini C, Brighton T. et al. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008; 117: 93-102.
    CrossrefPubMedGoogle Scholar
  • 7 Spencer FA, Ginsberg JS, Chong A. et al. The relationship between unprovoked venous thromboembolism, age, and acute myocardial infarction. J Thromb Haemost 2008; 6: 1507-1513.
    PubMedGoogle Scholar
  • 8 Sorensen HT, Horvath-Puho E, Pedersen L. et al. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study. Lancet 2007; 370: 1773-1779.
    CrossrefPubMedGoogle Scholar
  • 9 Becattini C, Vedovati MC, Ageno W. et al. Incidence of arterial cardiovascular events after venous thromboembolism: a systematic review and a meta-analysis. J Thromb Haemost 2010; 8: 891-897.
    CrossrefPubMedGoogle Scholar
  • 10 Folsom AR, Lutsey PL, Astor BC. et al. C-reactive protein and venous thromboembolism. A prospective investigation in the ARIC cohort. Thromb Haemost 2009; 102: 615-619.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Spencer FA, Emery C, Lessard D. et al. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 2006; 21: 722-727.
    CrossrefPubMedGoogle Scholar
  • 12 Spencer FA, Emery C, Lessard D. et al. Upper extremity deep vein thrombosis: a community-based perspective. Am J Med 2007; 120: 678-684.
    CrossrefPubMedGoogle Scholar
  • 13 Silverstein MD, Heit JA, Mohr DN. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-593.
    CrossrefPubMedGoogle Scholar
  • 14 Zhao HJ, Zheng ZT, Wang ZH. et al. „Triple therapy“ rather than „triple threat“: a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest 2011; 139: 260-270.
    CrossrefPubMedGoogle Scholar
  • 15 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133: 381S-453S.
    CrossrefPubMedGoogle Scholar
  • 16 Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol 2006; 25: 101-161.
    PubMedGoogle Scholar
  • 17 Kahn SR, Panju A, Geerts W. et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 2007; 119: 145-155.
    CrossrefPubMedGoogle Scholar
  • 18 Cohen AT, Tapson VF, Bergmann JF. et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: 387-394.
    CrossrefPubMedGoogle Scholar
  • 19 Amin A, Stemkowski S, Lin J. et al. Thromboprophylaxis rates in US medical centers: success or failure?. J Thromb Haemost 2007; 5: 1610-1616.
    CrossrefPubMedGoogle Scholar
  • 20 Piazza G, Rosenbaum EJ, Pendergast W. et al. Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients. Circulation 2009; 119: 2196-2201.
    CrossrefPubMedGoogle Scholar
  • 21 Piazza G, Goldhaber SZ. Improving clinical effectiveness in thromboprophylaxis for hospitalized medical patients. Am J Med 2009; 122: 230-232.
    CrossrefPubMedGoogle Scholar
  • 22 Piazza G, Goldhaber SZ. Computerized decision support for the cardiovascular clinician: applications for venous thromboembolism prevention and beyond. Circulation 2009; 120: 1133-1137.
    CrossrefPubMedGoogle Scholar
  • 23 Kucher N, Koo S, Quiroz R. et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352: 969-977.
    CrossrefPubMedGoogle Scholar
  • 24 Alpert JS. Are data from clinical registries of any value?. Eur Heart J 2000; 21: 1399-1401.
    CrossrefPubMedGoogle Scholar