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Demographics and Clinical Outcomes of Patients Younger than 40 Years Treated for Acute Venous Thromboembolism

D.T. Vlazny1, W. Wysokinski1, D.E. Houghton1, D.O. Hodge2, D.A. Froehling1, L.G. Peterson1, A.I. Casanegra1

1Mayo Clinic, Cardiovascular Medicine - Gonda Vascular Center, Rochester, United States, 2Mayo Clinic, Health Sciences Research, Jacksonville, United States

Abstract Number: PB2400

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment

Background: Patients younger than 40 years with acute venous thromboembolism (VTE) are thought to have different demographic characteristics and profile of risk factors compared to patients 40 to 75 years of age, which could be associated with different clinical outcomes.

Aims: Assess demographic profile, risk factors, and clinical outcomes such as VTE recurrence, major bleeding, clinically relevant non major bleeding (CRNMB) and survival in young patients treated with any anticoagulation (AC) for acute VTE and those treated only with direct oral anticoagulants (DOACs).

Methods: Consecutive patients enrolled in the Mayo Clinic VTE Registry between March 1, 2013 and November 30, 2019 for acute VTE were followed prospectively. Patient outcomes were assessed in person, by mailed questionnaire, or by a scripted phone interview.

Results: During the study period, there were 257 patients with age < 40 years and 2123 aged 40-75 years. Patients younger than 40 years were more often women with VTE provoked by trauma, hormonal therapy or pregnancy, or by other provoking factors, but far less often with underlying malignancy compared to patients with the age of 40-75 years (Table 1). Patients < 40 years old had lower mortality but bleeding clinical outcomes were not different than the reference age group (Table 2). VTE recurrence was also similar (2.43 versus 4.77 per 100 person-years, p=0.16). When comparing study groups for those patients treated with DOACs (n= 1392), clinical outcomes were still not statistically different with the exception of mortality.

Conclusions: Patients younger than 40 with acute VTE have a different demographic profile and set of risk factors but similar clinical outcomes compared to the reference age range. This does not change when patients are treated with DOACs. As expected, the age group < 40 had better survival compared to the group of patients between 40 and 75 years of age.

Variable Age <40 (n=257) Age 40-75 (n=2123) p-value Age <40, DOACs (n=168) Age 40-75, DOACs (n=1224) p-value
Female, n (%) 150 (58.4) 915 (43.1) <0.001 93 (55.4) 540 (44.1) 0.006
PE, n (%) 99 (38.5) 934 (44.0) 0.095 57 (33.9) 508 (41.5) 0.061
DVT and PE, n (%) 36 (14.0) 455 (21.4) 0.006 22 (13.1) 234 (19.1) 0.059
Provoked VTE, n (%) 207 (80.9) 1734 (81.8) 0.762 128 (76.6) 943 (77.1) 0.800
Active cancer, n (%) 49 (19.1) 1024 (48.2) <0.001 24 (14.3) 474 (38.6) <0.001
Trauma, n (%) 25(9.7) 118 (5.6) 0.008 22 (13.1) 81 (6.6) 0.003
Hormonal therapy/pregnancy, n (%) 61 (23.7) 50 (2.4) <0.001 35 (20.8) 38 (3.1) <0.001
Other provoking factors, n (%) 72 (28.0) 439 (20.7) 0.007 39 (23.2) 256 (20.9) 0.494
Patients receiving DOACs, n (%) 197 (76.7) 1554 (73.2) 0.235 —- —-  

[Table 1. Demographics and risk factors.]

Outcome Age <40 years Age 40-75 years p-value Age <40, DOACs Age 40-75, DOACs p-value
Mortality 12.02 30.37 <0.001 10.64 23.89 0.008
VTE recurrence 2.43 4.77 0.16 2.94 3.52 0.70
Major bleeding 3.04 4.92 0.24 2.94 3.05 0.90
CRNMB 4.28 7.00 0.16 4.97 8.32 0.21

[Table 2. Clinical outcomes during the total treatment period (rates per 100 person-years).]

To cite this abstract in AMA style:

Vlazny DT, Wysokinski W, Houghton DE, Hodge DO, Froehling DA, Peterson LG, Casanegra AI. Demographics and Clinical Outcomes of Patients Younger than 40 Years Treated for Acute Venous Thromboembolism [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/demographics-and-clinical-outcomes-of-patients-younger-than-40-years-treated-for-acute-venous-thromboembolism/. Accessed September 29, 2023.

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