Anticoagulation for Venous Thromboembolism: Impact on the Risk of Major Adverse Cardiovascular Events
Abstract
Background: It was recently established that patients who developed venous thromboembolism (VTE) are at increased risk of major adverse cardiovascular events (MACE) than the general population. However, whether the anticoagulation used for VTE influences the risk of MACE remains undescribed.
Research question: Does the anticoagulant treatment for VTE impact the risk of subsequent MACE?
Study design and methods: We included patients from a large prospective cohort, who received only one family of anticoagulant treatment after the acute phase of VTE, among which, vitamin K antagonist (VKA), and direct oral anticoagulants (DOAC). MACE included nonfatal acute coronary syndrome, non-fatal 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.
Results: A total of 3790 patients (47.2% of men, mean age: 60.48 years) were included. 1228 patients (32.4%) were treated for 0 to 3 months (median in overall population: 6 months).
Compared to these patients, those treated for 3 to 12 (HR: 0.64, 95% CI: 0.54 -0.76), or over 12 months (HR: 0.47, 95% CI: 0.39 -0.56) had a significant reduced risk of MACE after adjustment for confounders. Findings were similar for MACE-2 (HR-3-12 months: 0.61, 95% CI: 0.47 -0.79; HR-over 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 (HR: 0.48, 95% CI: 0.29 -0.77) in patients treated with DOAC (vs. VKA).
Interpretation: Treatment of VTE for more than 3 months is associated with a reduced risk of MACE, as is treatment with DOAC versus VKA. These findings, which may influence the choice of anticoagulation strategies for VTE, need confirmation by randomized clinical trials.
Related
- Risk factors of arterial thrombotic events after unprovoked venous thromboembolism, and after cancer associated venous thromboembolism: A prospective cohort study
- Factors Associated With Recurrent Venous Thromboembolism During Extended Apixaban Therapy for Cancer-Associated Thrombosis
- Prediction models for venous thromboembolism in pediatric patients: A protocol for systematic review and critical appraisal
- The incidence of early recurrent venous thromboembolism: a systematic review and meta-analysis
- Impact of hypnosis on patient experience after venous access port implantation
BibTeX
@article{noumegni2026anticoagulation,
title = {{Anticoagulation for Venous Thromboembolism: Impact on the Risk of Major Adverse Cardiovascular Events}},
author = {Steve Raoul Noumegni and Raphael Le Mao and Claire de Moreuil and Clément Hoffmann and Emmanuelle Le Moigne and Cécile Tromeur and Vincent Mansourati and Bahaa Nasr and Jean-Christophe Gentric and Marie Guegan and Elise Poulhazan and Luc Bressollette and Karine Lacut and Romain Didier and Francis Couturaud},
journal = {Chest},
year = {2026},
month = sep,
url = {https://hal.science/hal-05753551v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anticoagulation for Venous Thromboembolism: Impact on the Risk of Major Adverse Cardiovascular Events
AU - Steve Raoul Noumegni
AU - Raphael Le Mao
AU - Claire de Moreuil
AU - Clément Hoffmann
AU - Emmanuelle Le Moigne
AU - Cécile Tromeur
AU - Vincent Mansourati
AU - Bahaa Nasr
AU - Jean-Christophe Gentric
AU - Marie Guegan
AU - Elise Poulhazan
AU - Luc Bressollette
AU - Karine Lacut
AU - Romain Didier
AU - Francis Couturaud
PY - 2026
DA - 2026/09/17
JO - Chest
UR - https://hal.science/hal-05753551v1
AB - Background: It was recently established that patients who developed venous thromboembolism (VTE) are at increased risk of major adverse cardiovascular events (MACE) than the general population. However, whether the anticoagulation used for VTE influences the risk of MACE remains undescribed. Research question: Does the anticoagulant treatment for VTE impact the risk of subsequent MACE? Study design and methods: We included patients from a large prospective cohort, who received only one family of anticoagulant treatment after the acute phase of VTE, among which, vitamin K antagonist (VKA), and direct oral anticoagulants (DOAC). MACE included nonfatal acute coronary syndrome, non-fatal 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. Results: A total of 3790 patients (47.2% of men, mean age: 60.48 years) were included. 1228 patients (32.4%) were treated for 0 to 3 months (median in overall population: 6 months). Compared to these patients, those treated for 3 to 12 (HR: 0.64, 95% CI: 0.54 -0.76), or over 12 months (HR: 0.47, 95% CI: 0.39 -0.56) had a significant reduced risk of MACE after adjustment for confounders. Findings were similar for MACE-2 (HR-3-12 months: 0.61, 95% CI: 0.47 -0.79; HR-over 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 (HR: 0.48, 95% CI: 0.29 -0.77) in patients treated with DOAC (vs. VKA). Interpretation: Treatment of VTE for more than 3 months is associated with a reduced risk of MACE, as is treatment with DOAC versus VKA. These findings, which may influence the choice of anticoagulation strategies for VTE, need confirmation by randomized clinical trials.
SN - 0012-3692
SN - 1931-3543
ER -