30-Year Mortality Following Venous Thromboembolism: A Population-Based Cohort Study
Background—Studies on long-term mortality following venous thromboembolism (VTE) are sparse.
Methods and Results—Using Danish medical databases, we conducted a 30-year nationwide population-based cohort study of 128,223 patients with first-time VTE (1980-2011) and a comparison cohort of 640,760 persons from the general population (without VTE), randomly matched by gender, year of birth, and calendar period. The mortality risks for patients with deep venous thrombosis (DVT) and pulmonary embolism (PE) were markedly higher than for the comparison cohort during the first year, and especially within the first 30 days (3.0% and 31% vs. 0.4%). Using Cox regression, we assessed mortality rate ratios (MRRs) with 95% confidence intervals (CIs). The overall 30-year MRR was 1.55 (95% CI 1.53-1.57) for DVT and 2.77 (2.74-2.81) for PE. The 30-day MRR was 5.38 (5.00-5.80) for DVT and 80.87 (76.02-86.02) for PE. Over time, the 30-day MRR was consistently 5-6-fold increased for DVT, whereas it improved for PE from 138 (125-153) in 1980-1989 to 36.08 (32.65-39.87) in 2000-2011. The 1-10 year and 11-30 year MRRs remained 25%-40% increased after both DVT and PE, but were 3-5-fold increased after DVT and 6-11-fold increased after PE when considering VTE as the immediate cause of death.
Conclusions—Patients with VTE are at increased risk of dying, especially within the first year after diagnosis, but also during the entire 30-years of follow-up with VTE as an important cause of death. While 30-day mortality after DVT remained fairly constant over the last three decades, it improved markedly for PE.
- Received January 27, 2014.
- Revision received June 13, 2014.
- Accepted June 20, 2014.