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. 2022 Sep 28:15:7559-7568.
doi: 10.2147/IJGM.S359893. eCollection 2022.

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

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   2   3 , Khadega A Abuelgasim  1   2
Affiliations

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

Fahad A S AlEidan et al. Int J Gen Med. .

Abstract

Background: 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: active cancer; incidence; mortality; predictors; recurrent; venous thromboembolism.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the study population. A total of 1265 patients were identified with first VTE, 141 patients did not fulfill the inclusion criteria and were excluded. The final assessed numbers of the first VTE incident were 1124 patients. Of which 910 patients with no recurrent VTE (control group) and 214 patients with recurrent VTE.
Figure 2
Figure 2
Kaplan–Meier venous thromboembolism (VTE) recurrence probabilities curve by categorization of the index events. The estimate recurrence median time was significantly lower in cancer-related VTE (18.7 months) than provoked (29.0 months) and unprovoked VTE (28.4 months, p<0.001 by the Log rank test).
Figure 3
Figure 3
Kaplan–Meier venous thromboembolism (VTE) mortality probabilities curve by categorization of the index events. The estimate survival median time was significantly lower in cancer-related VTE (21.8 months) than in provoked VTE (30.5 months) and unprovoked VTE (29.8 months, p<0.001 by the Log rank test).
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