Recurrence rate of venous thromboembolic events in granulomatosis with polyangiitis

摘要

Objective The incidence of first-time venous thromboembolic events (VTEs) is high in granulomatosis with polyangiitis (GPA). The incidence of recurrent VTEs is unknown. We aimed to describe the recurrence rate of second VTEs in patients with GPA. Methods Retrospective chart review was performed in patients with GPA and at least one VTE at a single centre from 2002 to 2016. Inclusion criteria were 1990 ACR criteria or 2012 Revised International Chapel Hill nomenclature for GPA, at least two follow-up visits, at least one VTE during the study period, and VTE occurrence after or within 3 months before GPA diagnosis. Second VTE event-free survival rates were estimated. Results Out of 147 patients initially screened for GPA and with at least one VTE, 84 met inclusion criteria. Median age at first VTE was 57 years. Incidence rate for second VTE was 8.4 events per 100 patient-years (95 CI: 5.7, 12.3). Eighty-three point three per cent of first VTEs and 57.7 of second VTEs occurred when disease was active (P < 0.001). Renal involvement and constitutional symptoms at the time of first VTE were associated with VTE recurrence. Conclusion GPA has a high rate of VTE recurrence compared with the reported data in the general population with unprovoked VTE. Our results suggest that VTE in GPA is a recurrent co-morbidity, not always during active vasculitis, and more so in those with renal involvement and constitutional symptoms at the time of first VTE. Lay Summary What does this mean for patients? Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of diseases that cause inflammation of small blood vessels, referred to as vasculitis. Patients with AAV are at high risk of blood clots in the lower body and lungs. Patients who develop blood clots are often treated with blood thinners. However, we do not know how long patients should remain on blood thinners after their first blood clot. This is partly because we do not know whether blood clots are likely to recur in people with AAV. We studied 84 people with granulomatosis with polyangiitis (GPA), a type of AAV, who had at least one blood clot. We found that the recurrence of blood clots was higher in GPA patients than in the general population. The second blood clot did not always occur during active vasculitis. People with GPA who have disease in their kidneys owing to vasculitis and/or fever or weight loss are at higher risk of recurring blood clots. Our findings will help to guide future research into the monitoring of these patients, in addition to the length of time they should be treated with blood thinners.