Time trends and excess mortality compared to population controls after a first-time pulmonary embolism or deep vein thrombosis.

BACKGROUND

Recent data on temporal trends in excess mortality for patients with pulmonary embolism (PE) and deep vein thrombosis (DVT) compared to the general population is scarce.

METHODS

A nationwide Swedish register study 2006-2018 including 68,960 PE and 70,949 DVT cases matched with population controls. Poisson regression determined relative risk (RR) for 30-day and one-year mortality trends while Cox regression determined adjusted hazard ratios (aHR). A significance level of 0.001 was applied.

RESULTS

In PE cases, both 30-day mortality (12.5% in 2006 to 7.8% in 2018, RR 0.95 95% CI 0.95-0.96, p<0.0001) and one-year mortality (26.5% to 22.1%, RR 0.98 0.97-0.98, p<0.0001) decreased during the study period. Compared to controls, no significant change was seen in 30-day (aHR 33.08 25.12 - 43.55 to 24.64 18.81 - 32.27, p=0.0015 for interaction with calendar year) or one-year (aHR 5.85 5.31-6.45 to 7.07 95% CI 6.43-7.78, p=0.038) excess mortality. The 30-day excess mortality decreased significantly (aHR 39.93 28.47-56.00) to 24.63 17.94-33.83, p=0.0009) in patients with PE without known cancer before baseline, while the excess one-year mortality increased (aHR 3.55 3.16 - 3.99 to 5.38 4.85 - 5.98, p<0.0001) in PE cases surviving to fill a prescription of anticoagulation. In DVT cases, 30-day and one-year mortality declined while excess mortality compared to controls remained stable.

CONCLUSION

In general, the improved mortality following PE and DVT paralleled population trends. However, PE cases without cancer had decreasing excess 30-day mortality, whereas those surviving to fill a prescription for anticoagulant medication showed increasing excess one-year mortality.

Informations de copyright

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Déclaration de conflit d'intérêts

KGS has received speaker’s honoraria from Bristol-Myers Squibb, Pfizer, Bayer, and Leo Pharma. SS has received research grant from Octapharma and honoraria from Alexion, Bayer, Boehringer Ingelheim, Daiichi-Sankyo, Regeneron, Sanofi, Servier, Takeda, and Hemostasis Reference Lab. KS has received speaker’s honoraria from Leo Pharma. JP has received speaker’s honoraria from Pfizer. MT has received speaker’s honoraria from Viatris. CJS and AP report no conflict of interest.