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The impact of co-morbidity on the disease burden of VTE


Venous thromboembolism (VTE) is often accompanied by co-morbidities, which complicate and confound data interpretation concerning VTE-related mortality, costs and quality of life. We aimed to assess the contribution of co-morbidities to the burden of VTE. The PREFER in VTE registry, across seven European countries, documented and followed acute VTE patients over 12 months. Patients with co-morbidities were grouped in major co-morbidity groups: cancer, cardiovascular (CV) comorbidity (other than VTE), CV risks, venous, renal, liver, respiratory, bone and joint diseases, and lower extremity paralysis. Mortality rates and health-related quality of life (HrQoL) utility values grouped per co-morbidity were compared to the UK general population. Regression analyses were performed to determine the impact of co-morbidities on mortality and HrQoL. VTE were analyzed together and separately as pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 3455 patients were included, 40.5% with PE and 59.5% with DVT. 13% and 16% of the PE and DVT patients had no co-morbidities and had a 12-month mortality rate of 1.8% and 1.7%, respectively. Frequency and severity of co-morbidities increased mortality rates up to 30%. The EQ-5D-5L index in patients without co-morbidities were 0.826 and 0.838 for PE and DVT. These scores decreased to 0.638 and 0.555 in the presence of co-morbidities. Co-morbidities in VTE patients are common. VTE had an impact on mortality and HrQoL, and additional impact of co-morbidities was seen. Awareness of the presence of co-morbidities is important when making VTE-related treatment decisions. The presence of co-morbidities in PE and DVT patients is common and their frequency and severity in VTE patients have a substantial impact on mortality rates and HrQoL. When adjusting for co-morbidities, the impact of VTE on mortality as well as health-related quality of life remains present. Assessing patients without consideration of co-morbidities might lead to misinterpretations of the disease burden of PE and DVT.

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Data availability

The dataset analyzed during the current study are from the PREFER in VTE registry and are not publicly available.





Deep-vein thromboembolism


Pulmonary embolism


Venous thromboembolism


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The authors would like to acknowledge the invaluable contribution of the PREFER in VTE Registry investigators and patients.

Author information

SK, LHC, AC, BH, PG analyzed and interpreted the data and co-morbidity specific analyses. SK, LHC, AC, BH, PG, MM, SW, AG, RB, GA contributed in writing and reviewing of the manuscript.

Correspondence to Sonja Kroep.

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Conflict of interest

S. Kroep, LH. Chuang and B. van Hout have served as consultants for Daiichi-Sankyo; A. Cohen, M. Monreal, S. Willich, A. Gitt, R. Bauersachs and G. Agnelli have received honoraria from Daiichi-Sankyo for participating in the advisory committee; P. Gumbs is an employee of Daiichi-Sankyo Europe GmbH.

Ethics approval and consent to participate

Prior to study commencement, the registry protocol was approved by the responsible ethics committees for the participating countries and the relevant hospital-based institutional review boards. All patients enrolled in the registry first provided written informed consent. The design and methods of the PREFER in VTE registry have previously been described, including more information concerning patients, data collection and definitions [5].

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Kroep, S., Chuang, L., Cohen, A. et al. The impact of co-morbidity on the disease burden of VTE. J Thromb Thrombolysis 46, 507–515 (2018). https://doi.org/10.1007/s11239-018-1732-0

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  • Pulmonary embolism
  • Deep vein thrombosis
  • Risk factors
  • Quality of Life
  • Mortality