OC 34.5 - Identification of risk factors for major bleeding during anticoagulation and recurrent venous thromboembolism after its discontinuation in patients with a first unprovoked venous thromboembolism.

Monday, July 11, 2022

11:45 AM – 12:00 PM

Location: ExCel Center, ICC Capital Suite Room 14-16

Presentation Format: In-Person

Presenting Author(s)

Cristina Gabara, MD

Specialist
Hospital Clínic de Barcelona
Barcelona, Catalonia, Spain

Co-Author(s)

YY

Yugo Yamashita

Department of Cardiovascular Medicine
Kyoto University
Kyoto, Kyoto, Japan
JA

Jesús Aibar

Medical doctor
Hospital Clínic de Barcelona
Barcelona, Catalonia, Spain
CZ

Carles Zamora

Department of Internal Medicine
Hospital Clínc de Barcelona
Barcelona, Catalonia, Spain
JM

Jorge Moises

Senior consultant
Hospital Universitario Clinic, Barcelona, España
Barcelona, Catalonia, Spain
CF

Carme Font

MD, PhD
Medical Oncology Service, Hospital Clinic; Barcelona, Spain
Barcelona, Catalonia, Spain
RV

Reina Valle

Department of Internal Medicine
Hospital Sierrallana
Santander, Cantabria, Spain
AB

Alessandra Bura-Riviere

Department of Vascular Medicine
Hôpital de Rangueil
Toulouse, Languedoc-Roussillon, France
LM

Lucia Mazzolai

Head
Department of Angiology. Centre Hospitalier Universitaire Vaudois (CHUV). Lausanne. Switzerland.
Lausanne, Vaud, Switzerland
AL

Alicia Lorenzo

Department of Internal Medicine
Hospital Universitario La Paz
Madrid, Madrid, Spain
AB

Aitor Ballaz

Department of Pneumonology
Hospital de Galdakao
Vizcaya, Pais Vasco, Spain
OM

Olga Madridano

Dr
Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain
Madrid, Castilla y Leon, Spain
JS

José María Suriñach

Department of Internal Medicine
Hospital Universitario Vall d'Hebron
Barcelona, Catalonia, Spain
JF

José Luis Fernández-Reyes

Head
Department of Internal Medicine. Complejo Hospitalario de Jaén. Jaén. Spain.
Jaén, Andalucia, Spain
AV

Aurora Villalobos

MD
Hospital Regional Universitario de Málaga
Málaga, Andalucia, Spain
PV

Peter Verhamme, MD, PhD

MD, PhD
University Hospitals Leuven, Belgium
Leuven, Vlaams-Brabant, Belgium
JL

Juan Bosco López-Sáez

Department of Internal Medicine
Hospital Universitario de Puerto Real
Cádiz, Andalucia, Spain
AG

Aida Gil-Diaz

Department of Internal Medicine
Hospital Universitario Dr Juan Negrin
Las Palmas de Gran Canaria, Canarias, Spain
JV

Jerónimo Ramón Vela

Department of Internal Medicine
Hospital Universitario Miguel Servet
Zaragoza, Aragon, Spain
MM

Manuel Monreal

MD PhD
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain
Barcelona, Andalucia, Spain

Background: After 3 months of anticoagulation for a first unprovoked venous thromboembolism (VTE), the decision to prolong therapy must consider the risk of both, bleeding and recurrences.

Aims: To identify independent predictors for major bleeding during anticoagulation and recurrent VTE after its discontinuation.

Methods: Consecutive patients with a first episode of unprovoked VTE from RIETE were included. We analysed their clinical characteristics and treatment to find predictors of major bleeding during anticoagulation, and VTE recurrences after its discontinuation. A multivariate analysis using a Cox proportional hazard regression analysis was performed.

Results: Among 33,262 patients included in the analysis, 685 (2.1%) suffered major bleeding during anticoagulation. Independent predictors were: age >80 years (hazard ratio [HR], 2.63 ; 95% CI, 1.84-3.76), chronic lung disease (HR, 1.29 ; 95% CI, 1.05-1.59), liver cirrhosis (HR, 4.07 ; 95% CI, 1.98-8.37); recent major bleeding (HR, 4.02 ; 95% CI, 2.61-6.20), anaemia (HR, 1.88 ; 95% CI, 1.60-2.21); CrCl levels 30-60mL/min (HR, 1.47 ; 95% CI, 1.20-1.80) or < 30mL/min (HR, 1.96 ; 95% CI, 1.46-2.64) and concomitant use of corticosteroids (HR, 1.52; 95% CI, 1.18-1.94) or thrombolytic drugs (HR, 3.43; 95% CI, 2.42-4.85) (Table 1).

Among 11,764 patients followed-up after discontinuing anticoagulation, 1,403 (12%) developed VTE recurrences. Age >80 years (HR, 1.32; 95% CI, 1.08-1.61) and use of direct oral anticoagulants (HR, 1.25; 95% CI, 1.01-1.55) predicted the risk (Table 1).

Conclusion(s): Among patients with unprovoked VTE, a number of variables easily obtained at baseline may reliably predict the risk for major bleeeding during anticoagulation. To identify predictors of VTE recurrences after discontinuation was more elusive.