Long-term mortality and causes of death after venous thromboembolism: findings from the Atherosclerosis Risk in Communities Cohort Study

BACKGROUND: More than 1 million people in the United States develop venous thromboembolism (VTE) annually, but little is known about long-term mortality and causes of death after VTE. OBJECTIVES: The objective of this study was to investigate long-term mortality and causes of death after VTE, by VTE type. METHODS: Atherosclerosis Risk in Communities cohort participants free of VTE at baseline were followed from 1987-1989 through 2019 for first-time VTE (unprovoked, cancer-provoked, or other provoked) and death. The hazard ratios (HRs) of death and the proportion who died for each cause of death after first VTE were estimated by VTE type. RESULTS: The main causes of death after overall VTE were cancer (36%) and circulatory diseases (27%). After unprovoked VTE, 36% died of circulatory diseases and 13% of cancer. Those values were similar for other-provoked VTE. For cancer-provoked VTE, 80% died of cancer and 11% of circulatory diseases. Five years after overall VTE, the HR of death was 2.7 (95% CI: 2.6-3.0). This HR was highest for cancer-provoked VTE (HR, 5.5; 95% CI, 4.3-6.9). Those with unprovoked (HR, 1.9; 95% CI, 1.7-2.2) and other-provoked VTE (HR, 2.4; 95% CI, 2.0-2.7) also had elevated risk. Ten years after VTE, those with any VTE, unprovoked VTE, and other-provoked VTE had a 60% higher risk of death (95% CI for each 1.3-1.5 to 1.9). CONCLUSIONS: Long-term mortality risk after VTE in this United States cohort was higher than among people without VTE. Apart from those with cancer-provoked VTE, circulatory diseases were the primary cause of death after VTE.