Severity of disease and location of incident thromboembolic event may be associated with recurrent venous thromboembolism (VTE) in patients with sickle cell disease (SCD), according to a study published in the American Journal of Hematology.
Incidence of VTE recurrence at least 30 days after incident VTE and bleeding were assessed in a cohort of 6423 patients with SCD, 877 of whom experienced an incident acute VTE event. Pulmonary embolism (PE) with or without deep vein thrombosis (DVT) accounted for 57.7% of cases, DVT alone accounted for 23.5% of cases, and upper extremity DVT alone accounted for 18.8% of cases.
There were 257 recurrent VTE events. Median time to recurrence was 13.3 months, and 65.4% of events occurred within 90 days of hospitalization. The cumulative incidence of recurrence was 13.2% at 1 year and 24.1% at 5 years.
Patients with severe SCD were more likely to experience recurrent VTE events compared with patients with less severe SCD (28.4% vs 12.2% at 5 years; hazard ratio [HR], 2.41). Recurrence incidence was also higher among patients who experienced lower extremity DVT compared with patients who experienced PE (HR, 1.64) or upper extremity DVT, as well as among patients with pneumonia or acute chest syndrome (HR, 1.68).
Of the 877 patients who experienced an incident VTE, 245 experienced a bleeding event, with a median time to occurrence of 25.1 months. Gastrointestinal bleeding occurred in 40.8% of cases, epistaxis in 22.9%, menorrhagia in 12.7%, and intracranial bleeding in 6.9%. Cumulative bleeding incidence was 4.9% and 7.9% at 6 and 12 months post-VTE, respectively.
A higher bleeding incidence was observed in patients with severe SCD (10.1% at 12 months) compared with patients with less severe disease (3.5% at 12 months; HR, 1.61). Older age (P =.01) and prior history of bleeding were also found to be associated with bleeding after VTE.
The authors noted that patients with SCD who experienced VTE may benefit from indefinite anticoagulation, though this must be balanced against the high risk of bleeding in this patient population. “A prospective, multicenter, randomized trial may be warranted and feasible given the frequency of VTE in this population, the authors concluded.
1. Brunson A, Keegan T, Mahajan A, White R, Wun T. High incidence of venous thromboembolism recurrence in patients with sickle cell disease [published online May 9, 2019]. Am J Hematol. doi:10.1002/ajh.25508