OC 23.5 - Identifying phenotypes of deep vein thrombosis and their relation to clinical outcomes beyond recurrence

Sunday, July 10, 2022

3:45 PM – 4:00 PM

Location: ExCel Center, ICC Capital Suite Room 7&12

Presentation Format: In-Person

Presenting Author(s)

Aaron F.J. Iding, MD

PhD candidate
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Thrombosis Expertise Center, Heart+ Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands

Co-Author(s)

Alejandro Pallares Robles

PhD student
Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz (UMCM), Mainz, Germany
Mainz, Rheinland-Pfalz, Germany
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Vincent ten Cate

Postdoc
Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz (UMCM), Mainz, Germany
Mainz, Rheinland-Pfalz, Germany
Hugo ten Cate, MD, PhD, FAHA

Professor, MD, PhD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
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Philipp S. S. Wild

Professor
Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz (UMCM), Mainz, Germany
Mainz, Rheinland-Pfalz, Germany
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Arina J. ten Cate-Hoek

Associate Professor, MD
Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands

Background: Deep vein thrombosis (DVT) is a multifactorial disease with several clinical outcomes, but current classifications are based on few factors and solely stratify recurrence risk.

Aims: We aimed to identify DVT phenotypes and assess their relation to recurrent venous thromboembolism (VTE), post-thrombotic syndrome (PTS), arterial events and cancer.

Methods: Hierarchical clustering was performed on a single-center cohort of patients with proximal DVT using 23 prospectively recorded characteristics (i.e., demographics, provoking factors, cardiovascular risk factors and comorbidities). Phenotypes were summarized by their discriminative characteristics. Cox regression was used for time-to-event analyses. Follow-up duration was up to five years. The study was carried out in accordance with the Declaration of Helsinki and the medical ethics committee approved data collection.

Results: A total of 825 patients were clustered into four distinct phenotypes: (1, n=112) younger females with estrogen therapy; (2, n=268) older patients with a cardiovascular risk profile; (3, n=128) patients with previous VTE and known thrombophilia; and (4, n=317) patients without discriminative characteristics. Overall, risks of recurrence and other clinical outcomes were lowest in phenotype 1 and highest in phenotype 2, except for PTS and cancer for which phenotype 3 had the highest risk. Phenotype 4 had overall intermediate risks (Figure 1). Notably, phenotype 1 largely overlapped with current classifications of provoked DVT, while phenotypes 2, 3 and 4 harbored different proportions of unprovoked DVT.

Conclusion(s): Hierarchical clustering identified four distinct risk profiles among DVT patients that are not only associated with increasing risk for recurrence but also with outcomes beyond recurrence. Our results thereby highlight the limitations of current risk stratifications that dichotomize risks based on VTE provoking factors only. Moreover, patients with a cardiovascular risk profile were identified as being at the highest risk of arterial events and recurrence.