Sex differences in risk of incident venous thromboembolism in heart failure patients
In patients with incident heart failure, the risk of venous thromboembolism (VTE), defined as pulmonary embolism (PE) and/or deep venous thrombosis (DVT), is sparsely described, especially potential sex differences. We conducted an observational study to evaluate risk of VTE among male and female heart failure patients.
Population-based cohort study of patients diagnosed with incident heart failure during 2000–2015, identified by record linkage between nationwide registries in Denmark. Using a pseudo-value approach, we calculated relative risks [RR] of VTE at 1 and 3 years of follow-up. Crude VTE risk for males and females are reported and contrasted after adjustment for established clinical risk factors for VTE.
A total of 32,330 heart failure patients were included, of which 15,238 (47%) were females. For the combined endpoint of VTE, female sex was associated with a higher risk (1-year adjusted RR: 1.30, 95% confidence interval [CI]: 0.97–1.73; 3-year adjusted RR: 1.34, 95% CI: 1.07–1.67) compared to male patients. For the individual endpoints of PE and DVT after 1-year of follow-up, female sex was only associated with a higher risk of PE and not DVT, compared to male patients. However, female sex was associated with a higher risk of both PE and DVT after 3 years of follow-up.
Among incident heart failure patients, female sex is associated with a higher risk of VTE, mainly driven by an excess risk of PE. This finding may help improve clinical decision-making regarding VTE prophylaxis in patients with heart failure.
KeywordsHeart failure Sex Venous thromboembolism Deep vein thrombosis Pulmonary embolism
Deep vein thrombosis
Line Melgaard, Peter Brønnum Nielsen, and Flemming Skjøth had full access to all of the data in this study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the design, analysis, interpretation of data, drafting the article, or revising it critically for important intellectual content and approved the final version to be published. Statistics Denmark provided the data for this study.
The Obel Family Foundation.
Compliance with ethical standards
Conflict of interest
Professor Lip: Consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. Associate Professor Larsen: An investigator for Janssen Scientific Affairs, LLC, and Boehringer Ingelheim. Speaker for Bayer, BMS/Pfizer, Janssen Pharmaceuticals, Takeda, Roche Diagnostics, and Boehringer Ingelheim. Peter Brønnum Nielsen: Speaker for Boehringer Ingelheim and Bayer Pharma AG; research Grant from BMS/Pfizer. Flemming Skjøth: Consultancy fees from Bayer. Other authors—none declared. Profs Lip and Larsen are guarantors of this paper.
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