title: Family history of venous thromboembolism and mortality after venous thromboembolism: a Swedish population-based cohort study.
abstract: Studies on whether family history (FH) of venous thromboembolism (VTE) affects long-term mortality after VTE are missing. The aim of this study was to determine whether FH of VTE affects long-term mortality after a first episode of VTE. Using Swedish medical databases, we conducted a 30-year nationwide cohort study of 49,159 adult Swedish born patients included in the multi-generation register (born 1932 or later) with a first-time VTE (1981-2010). Using Cox regression, we assessed mortality Hazard ratios (HRs) with 95% confidence intervals (CIs). Totally 10,093 (20.5%) patients with VTE had a first-degree FH of VTE (parent/sibling). Patients without FH of VTE had significantly more VTE provoking risk factors and comorbidities than those with FH. The mortality HR the first 10-years after first time VTE was decreased for those with FH of VTE compared to for those without FH: crude HR 0.807, 95% CI 0.771-0.845 and adjusted HR 0.864, 95% CI 0.826-0.905. After 10-years of follow-up there was no significant effect of FH of VTE on mortality: crude HR = 1.018, 95% CI 0.905-1.145 and adjusted HR = 0.995, 95% CI 0.884-1.119. Cancer-associated mortality was more common in those without FH the first 10 years (56.9 vs. 53.4%, p = 0.002). After 10 years there were no difference in cancer-associated mortality (4.9 vs. 5.6%, p = 0.604). The results suggest that patients with FH of VTE have lower thrombotic threshold and need less provoking factors and comorbidities. They have also slightly lower total and cancer mortality the first 10 years after VTE.
authors.affiliation: Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden. bengt.zoller@med.lu.se.
authors.forename: Bengt
authors.identifier: http://orcid.org/0000-0002-8250-5613
authors.initials: B
authors.lastname: Zöller
authors.affiliation: Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden.
authors.forename: Mirnabi
authors.initials: M
authors.lastname: Pirouzifard
authors.affiliation: Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000150:complications / Q000401:mortality*
keywords: Comorbidity; Deep venous thrombosis; Family history; Genetics; Mortality; Pulmonary embolism; Venous thromboembolism