# Increased risk of deep vein thrombosis, pulmonary embolism, and all-cause mortality in chronic venous disorder: a large-scale retrospective cohort study

## TL;DR

Chronic venous disorder increases the risk of blood clots and death, but procedures can reduce these risks.

## Contribution

Large-scale evidence showing CVD increases thromboembolic events and mortality, with procedural interventions reducing these risks.

## Key findings

- CVD is associated with increased risks of DVT, PE, and all-cause mortality.
- Procedural interventions in CVD patients reduce risks of DVT, PE, and mortality.
- Risks persist even after adjusting for disease severity.

## Abstract

Chronic venous disorder (CVD), often overlooked as a significant medical burden, has recently been linked to severe health risks, especially deep vein thrombosis (DVT), and pulmonary embolism (PE). However, large-scale data are lacking. Specifically, the impact of CVD severity on the risk of thromboembolic events and the impact of procedural interventions on these risks are unknown.

A retrospective cohort study of mortality and serious adverse events was conducted using electronic health records derived from the TriNetX database. Propensity-score matching and sensitivity analyses were performed to mitigate bias.

We included 463,313 patients with CVD. An increased risk of superficial vein thrombosis [SVT; hazard ratio (HR), 19.0, 95% confidence interval (CI) 17.1–21.0, p < 0.0001], DVT (3.3, 3.2–3.6), PE (2.1, 2–2.1), and mortality (1.8, 1.8–1.8) were observed. These results persisted in two sensitivity analyses. When stratifying CVD for disease severity into chronic venous disease and -insufficiency, elevated risks of thromboembolic events and all-cause mortality were observed in both groups. Comparing CVD patients with interventions to those without, the risk of DVT (0.9, 0.8–0.9), PE (0.6, 0.5–0.6) and all-cause mortality (0.5, 0.5–0.5) decreased. Conversely, the risk of SVT increased (1.8, 1.6–2.0).

Independently of disease severity, CVD entails an increased risk for venous thromboembolic events and all-cause mortality. In CVD patients, procedural interventions are associated with reduced risks for DVT, PE and all-cause mortality. Confirmation of these potentially clinically relevant findings necessitates prospective randomized trials.