• Steve Raoul Noumegni, Raphael Le Mao, Claire de Moreuil, Clément Hoffmann, Emmanuelle Le Moigne, Cécile Tromeur, Vincent Mansourati, Bahaa Nasr, Jean-Christophe Gentric, Marie Guegan, Elise Poulhazan, Luc Bressollette, Karine Lacut, Romain Didier, and Francis Couturaud.
• Internal Medicine, Vascular Medicine and Pneumology Department, Brest Teaching Hospital, Brest, France; Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France. Electronic address: stevenoumegni91@yahoo.com.
• Chest. 2022 Nov 1; 162 (5): 114711621147-1162.

BackgroundIt was recently established that patients who developed VTE are at increased risk of major adverse cardiovascular events (MACE) compared with the general population. However, whether the anticoagulation used for VTE influences the risk of MACE remains undescribed.Research QuestionDoes the anticoagulant treatment for VTE affect the risk of subsequent MACE?Study Design And MethodsThis study included patients from a large prospective cohort who received only one family of anticoagulant treatment after the acute phase of VTE, including vitamin K antagonist (VKAs) and direct oral anticoagulants (DOACs). MACE included nonfatal acute coronary syndrome, nonfatal stroke, and all-cause death. The secondary outcome, MACE-2, included cardiovascular death instead of all-cause death. Cox proportional and Fine-Gray models served to study the relationship between anticoagulation characteristics and the risk of outcomes.ResultsA total of 3,790 patients (47.2% male; mean age, 60.48 years) were included. A total of 1,228 patients (32.4%) were treated for 0 to 3 months (median in overall population, 6 months). Compared with these patients, those treated for 3 to 12 months (hazard ratio [HR], 0.64; 95% CI, 0.54-0.76) or > 12 months (HR, 0.47, 95% CI, 0.39-0.56) had a significant reduced risk of MACE following adjustment for confounders. Findings were similar for MACE-2 (sub-HR for 3-12 months, 0.61 [95% CI, 0.47-0.79]; sub-HR > 12 months, 0.52 [95% CI, 0.39-0.68]). After adjustment for confounders, there was a reduced risk of MACE (HR, 0.53; 95% CI, 0.39-0.71) and MACE-2 (sub-HR, 0.48; 95% CI, 0.29-0.77) in patients treated with DOACs (vs VKAs).InterpretationTreatment of VTE for > 3 months is associated with a reduced risk of MACE, as is treatment with DOACs vs VKAs. These findings, which may influence the choice of anticoagulation strategies for VTE, need confirmation by randomized clinical trials.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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