Background: Patients with venous thromboembolism (VTE) have a high risk of subsequent arterial thrombosis. This may be explained by sharing some acquired risk factors, but the role of inherited thrombophilia in the occurrence of arterial thrombosis after VTE is still unknown.
Aims: To evaluate the incidence of arterial thrombosis after VTE in patients with or without inherited thrombophilia.
Methods: This single-center retrospective cohort study included patients referred to our center from Jan 2009 to Dec 2018 for a thrombophilia work-up after an episode of VTE (deep vein thrombosis of the lower limbs and/or pulmonary embolism). Patients with arterial thrombosis before VTE, on antiplatelets therapy or with antiphospolipid antibodies were excluded. The observational period lasted a maximum of 5 years from the date of anticoagulation withdrawal to the date of arterial thrombosis, recurrent VTE, or last visit. Such arterial thrombosis as myocardial infarction, ischemic stroke, transient ischemic attack, arterial thrombosis of the lower limbs, and acute mesenteric ischemia were considered.
Results: This preliminary report evaluated 563 patients, of whom 237 met the inclusion criteria (91 with and 146 without thrombophilia abnormalities). Baseline characteristics are shown in Table1. Arterial thrombosis was observed in 14 patients, for an incidence rate of 2.3% (95% CI 1.3-3.8%) patient-year. Patients with thrombophilia had a higher risk of arterial thrombosis after VTE than those without (IR 4.3%, 95% CI 2.2-7.5% vs 1.1%, 95% CI 0.4-2.6% patient-year, HR 3.59, 95% CI 1.19-11.53).
| Characteristics | VTE patients N=237 | Characteristics | VTE patients N=237 |
| Male, n (%) | 110 (46) | Cardiovascular risk factors, n (%) | |
| Age at VTE, mean (st dev) | 43 (15) | Smoking | 58 (25) |
| BMI class | Hypercholesterolemia | 150 (44) | |
| Normal weight | 120 (51) | Diabetes | 4 (2) |
| Overweight | 78 (33) | Hypertension | 38 (16) |
| Obesity | 39 (16) | Inherited thrombophilia*, n (%) | |
| Any | 146 (62) | ||
| Severe | 21 (9) | ||
| Mild | 70 (30) |
Baseline characteristics of patients included in the study
*severe thrombophilia included antithrombin, protein C and protein S deficiency, homozygous factor V Leiden and prothrombin G20210A mutations and double heterozygosis; mild thrombophilia included heterozygous of factor V Leiden and prothrombin G20210A mutations and high factor VIII plasma levels.
Kaplan-Meier curves for the risk of arterial thrombosis after VTE
Conclusions: Patients with inherited thrombophilia have a higher risk to develop arterial thrombosis after VTE. Thrombophilia screening could be useful to identify patients with a higher risk of arterial thrombosis after VTE.
To cite this abstract in AMA style:
Ciavarella A, Abbattista M, Gianniello F, Capecchi M, Artoni A, Martinelli I, Peyvandi F. Role of Inherited Thrombophilia in the Occurrence of Arterial Thrombosis after Venous Thromboembolism [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/role-of-inherited-thrombophilia-in-the-occurrence-of-arterial-thrombosis-after-venous-thromboembolism/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/role-of-inherited-thrombophilia-in-the-occurrence-of-arterial-thrombosis-after-venous-thromboembolism/