30-Year Mortality Following Venous Thromboembolism: A Population-Based Cohort Study
What is the natural history and associated mortality risk in patients who develop a venous thromboembolism (VTE)?
Using a Danish national medical database, 128,223 patients with a first-time VTE between 1980 and 2011 were compared to a cohort of 640,760 patients from the general population without VTE. Control patients were matched to VTE case patients based on gender, birth year, and year of VTE occurrence. Thirty-year mortality was assessed for patients with either a deep venous thrombosis (DVT) or pulmonary embolism (PE).
Patients who developed VTE were at increased risk of mortality compared to control patients, most pronounced in the first year of follow-up. Thirty-year mortality rate ratio was 1.55 (95% confidence interval [CI], 1.53-1.57) for DVT patients and 2.77 (95% CI, 2.74-2.81) for PE patients. Thirty-day mortality risk was 3% for DVT patients, 31% for PE patients, and 0.4% for non-VTE patients (adjusted rate ratio, 5.38 [5.0-5.80] for DVT patients and 80.87 [76.02-86.02] for PE patients). The 30-day rate ratio was consistent for DVT, but declined for PE patients over the study period (138 [125-153] in 1980-1989 to 36.08 [32.65-39.87] in 2000-2011). Mortality risk between days 31-364 was 13% for DVT patients, 20% for PE patients, and 4% for the non-VTE patients (adjusted rate ratio, 2.88 [2.80-2.97] for DVT patients and 4.2 [4.06-4.35] for PE patients). Beyond 1-year post-VTE, mortality risk remained elevated in VTE patients, but continued to decline over time.
The authors concluded that patients with a first-time VTE event are at markedly increased risk of dying within the first year. The risk appears highest in patients who suffer a PE. While the risk is highest in the initial post-VTE period, it remained elevated out to 30 years. Over the past three decades, mortality has remained constant for DVT patients, but improved significantly for PE patients.
This population-based, case-control study highlights the significant mortality risk associated with VTE. Perhaps most striking is the notable decline in mortality risk for PE patients without a notable change in mortality risk among DVT patients over the past 30+ years. It is important to remember that VTE can be both a cause of death (massive PE) as well as a marker for underlying diseases, such as malignancy. In addition to guideline-based anticoagulation measures to treat an acute VTE, practitioners should explore for underlying causes of VTE, including age-appropriate cancer screening in affected individuals.
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