OC 23.1 - Clinical outcomes and use of antithrombotic therapy in patients with peripheral artery disease with incident venous thromboembolism: a Dutch nationwide cohort study

Sunday, June 23, 2024

14:45 – 15:00 ICT

Room: Ballroom B3

Presenting Author(s)

Jamilla Goedegebuur, MD

PhD candidate
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

NK

Niels Keekstra

MD
Department of Medicine, section of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
B. Bikdeli

MD
Department of Medicine, Bringham and Women’s hospital, Boston, Massachusetts, United States of America
Boston, Massachusetts, United States
AP

Angelo Porfidia

MD
Department of Ageing, Neurosciences, Head-neck and Orthopaedics sciences, Agostino Gemelli University Polyclinic, Rome, Italy
Rome, Lazio, Italy
EB

Elena Butera

Dr.
Department of Ageing, Neurosciences, Head-neck and Orthopaedics sciences, Agostino Gemelli University Polyclinic, Rome, Italy
Rome, Lazio, Italy
Walter Ageno, MD

Professor
University of Varese
Bellinzona, Ticino, Switzerland
RP

Roberto Pola

MD
Department of Internal Medicine and Geriatrics, Agostino Gemelli University Polyclinic, Rome, Italy
Rome, Lazio, Italy
Stefano Barco

MD, PhD
Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
Zurich, Zurich, Switzerland
Jv

Joost van der Vorst

Vascular surgeon, MD PhD
Department of Medicine, section of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
Suzanne C. Cannegieter

MD, PhD, prof
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Leiden, Zuid-Holland, Netherlands

Background: Following guidelines, patients with peripheral artery disease (PAD) should use antithrombotic therapy (ATT) as secondary prevention of thromboembolic events. However, it remains unclear how to treat “breakthrough” venous thromboembolic events (VTEs) and what the consequences are of current practice patterns.

Aims: This study aims to describe current ATT prescription patterns in PAD patients before, during, and after VTE occurrence and to describe subsequent clinical outcomes.

Methods: In this cohort study, data from Dutch nationwide registry databases (Statistics Netherlands and Vektis) were used to identify PAD patients using reimbursement codes. Patients who developed VTE between January 1st 2016 and 2022 were identified by ICD-10 codes (registered after hospital admission) and included in the study. ATT-prescriptions were mapped in three different timeframes: three months before VTE, during VTE-treatment (three months of VTE-treatment + one month as ‘gap-period’) and four to twelve months after VTE.

Results: 925 patients with PAD who developed a VTE were included. Mean age of the cohort was 72.3 years (SD 10.57) (Table) with a median survival of 3.3 years (95%CI 2.9, 3.9). 202 (21.8%) patients died during their VTE-treatment period (i.e. within four months after VTE). Before the VTE, 66.3% of the patients used a platelet inhibitor only, in contrast to 12.6% of the patients after VTE-treatment (Figure). Most patients were prescribed a direct oral anticoagulant (DOAC) as VTE-treatment (56%), either alone or in combination with another type of ATT. 37.9% were treated with anticoagulation plus a platelet inhibitor during the VTE-treatment period.

Conclusion(s): A large proportion of patients with PAD died shortly after a VTE diagnosis. Immediate and long-term treatment of VTE in PAD patients was very heterogenous in our cohort. By the time of the ISTH congress, we will be able to report the cumulative incidences of adverse events.