Risk of cardiovascular events in patients diagnosed with venous thromboembolism

Cardiovascular disease is a leading cause of mortality globally. Whether venous thromboembolism (VTE) increases the risk of subsequent arterial cardiovascular events (ACVE) remains unclear. We examined the risk of future ACVE in a large emergency department (ED) cohort of patients with and without VTE.

This retrospective cohort study included all adults (≥18 years) presenting to five EDs in Stockholm 2016-2017. Patients diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) were identified; the remaining patients formed the comparison group. Individuals with prior ACVE were excluded. Fine-Gray subdistribution hazard models estimated crude and adjusted hazard ratios (HRs) for ACVE, cardiovascular death, and all-cause mortality, adjusting for age, sex, and key comorbidities. Mean follow-up was 1.2 years for ACVE and 2.1 years for mortality.

Among 308,779 patients, 3,610 had DVT and 2,358 had PE. ACVE occurred in 70 (1.9%) of DVT and 59 (2.5%) of PE patients, versus 4,870 (1.6%) of patients in the comparison group. Adjusted HRs for ACVE in DVT were 0.77 (95% CI, 0.47-1.25) at 30 days, 0.76 (0.58-0.99) at 1 year, and 0.74 (0.59-0.94) at full follow-up. For PE, the corresponding HRs were 0.46 (0.22-0.96), 0.87 (0.65-1.16), and 0.86 (0.67-1.12), respectively. All-cause mortality was significantly elevated in both groups: HRs for DVT and PE were 1.64 (1.48-1.82) and 2.37 (2.14-2.63), respectively.

VTE was not associated with an increased risk of ACVE. Both DVT and PE were linked to significantly elevated all-cause mortality.