Highlights
- •Diabetes was associated with increased rates for all-cause death.
- •Diabetes was associated with higher rate of arterial ischemic events.
- •Higher mortality rate could not be attributed to diabetes itself.
- •Influence of arterial events or antiplatelet drugs (if any) was low.
Summary
Background
Among patients presenting with pulmonary embolism (PE), those with diabetes are at
increased risk to die than those without diabetes. The reasons have not been identified.
We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to compare the mortality rate and the causes of death during anticoagulation
in patients with PE according to the presence or absence of diabetes.
Methods
A matched retrospective cohort study from consecutively enrolled patients in RIETE,
from 179 hospitals in 24 countries. For each patient with diabetes we selected two
patients with no diabetes matched by age, sex and year of diagnosis of the PE.
Results
As of September 2017, there were 2010 PE patients with diabetes and two age-and-gender
matched controls. Mean age was 74 ± 11 years, 46% were men. Patients with diabetes
were more likely to have co-morbidities, to be using antiplatelets and to have more
severe PE. During anticoagulation (median, 219 days), patients with diabetes had a
higher mortality (hazard ratio [HR]: 1.45; 95% confidence intervals [CI]: 1.25–1.67)
and a higher rate of arterial ischemic events (HR: 2.89; 95%CI: 1.71–4.94) than those
without diabetes. On multivariable analysis, diabetes was not associated with an increased
risk for death (HR: 1.26; 95%CI: 0.97–1.63). We also failed to find differences according
to the use of antiplatelet drugs concomitantly.
Conclusions
In our cohort of patients with PE, diabetes was not an independent predictor for death.
The influence of arterial events or antiplatelet drugs (if any) was low.
Keywords
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References
- Cardiovascular risk factors and venous thromboembolism: a meta-analysis.Circulation. 2008; 117: 93-102
- Diabetes mellitus and venous thromboembolism: a systematic review and meta-analysis.Diabetes Res Clin Pract. 2016; 111: 10-18
- Is diabetes mellitus a risk factor for venous thromboembolism? A systematic review and meta-analysis of case-control and cohort studies.Eur J Intern Med. 2016; 28: 52-58
- Is diabetes mellitus an independent risk factor for venous thromboembolism?: a population-based case-control study.Arterioscler Thromb Vasc Biol. 2009; 29: 1399-1405
- Diabetes mellitus and risk of venous thromboembolism.Am J Med Sci. 2009; 337: 259-264
- Coagulation and fibrinolysis in diabetes.Diab Vasc Dis Res. 2010; 7: 260-273
- Hypercoagulability in patients with type 2 diabetes mellitus detected by a thrombin generation assay.J Thromb Thrombolysis. 2011; 31: 165-172
- High coagulation factor levels and low protein C levels contribute to enhanced thrombin generation in patients with diabetes who do not have macrovascular complications.J Diabetes Complications. 2014; 28: 365-369
- Is diabetes a hypercoagulable state? A critical appraisal.Acta Diabetol. 2015; 52: 1007-1016
- Dynamic role of microparticles in type 2 diabetes mellitus.Curr Diabetes Rev. 2009; 5: 245-251
- The prevalence of pulmonary embolism and pulmonary hypertension in patients with type II diabetes mellitus.Chest. 2005; 128: 3568-3571
- Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study.Thromb Haemost. 2015; 114: 812-818
- Diabetes is associated with increased risk of venous thromboembolism: a systematic review and meta-analysis.Thromb Res. 2015; 135: 90-95
- Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain: analysis of hospital discharge data during 2004-2013.Respirology. 2016; 21: 1277-1284
- Venous thromboembolism in patients with diabetes mellitus.Am J Med. 2012; 125: 709-716
- Venous thromboembolism and risk of cancer in patients with diabetes mellitus.J Diabetes Complications. 2016; 30: 603-607
- Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism.J Thromb Haemost. 2016; 14: 121-128
- In-hospital mortality for pulmonary embolism: relationship with chronic kidney disease and end-stage renal disease. The hospital admission and discharge database of the Emilia Romagna region of Italy.Intern Emerg Med. 2013; 8: 735-740
- Blood glucose on admission and mortality in patients with venous thromboembolism.J Diabetes Complications. 2017; 31: 358-363
- Elevated admission glucose and mortality in patients with acute pulmonary embolism.Diabetes Care. 2012; 35: 25-31
- Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: results of the Tokyo CCU network registry.J Cardiol. 2015; 66: 460-465
- Predictors and causes of long-term mortality in elderly patients with acute venous thromboembolism: a prospective cohort study.Am J Med. 2017; 130: 198-206
- Long-term effects of unprovoked venous thromboembolism on mortality and major cardiovascular events.J Am Heart Assoc. 2017; 6
- Rationale, design and methodology of the computerized registry of patients with venous thromboembolism (RIETE).Thromb Haemost. 2018; 118: 214-224
- Recurrence of venous thromboembolism in patients with recent gestational deep vein thrombosis or pulmonary embolism: findings from the RIETE registry.Eur J Intern Med. 2016; 32: 53-59
- Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy.Eur J Intern Med. 2014; 25: 821-825
- Comparison of four scores to predict major bleeding in patients receiving anticoagulation for venous thromboembolism: findings from the RIETE registry.Intern Emerg Med. 2014; 9: 847-852
- Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer. Findings from the RIETE registry.Thromb Res. 2013; 131: 24-30
- Effect of the time of diagnosis on outcome in patients with acute venous thromboembolism. Findings from the RIETE registry.Thromb Haemost. 2011; 105: 45-51
- Major bleeding as a predictor of mortality in patients with venous thromboembolism: findings from the RIETE registry.J Thromb Haemost. 2010; 8: 2575-2577
- Prevalence of echocardiography use in patients hospitalized with confirmed acute pulmonary embolism: a real-world observational multicenter study.PLoS One. 2016; 11e0168554
- Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies.Diabetes Care. 2000; 23: 962-968
- Diabetes is an independent risk factor for stroke recurrence in stroke patients: a meta-analysis.J Stroke Cerebrovasc Dis. 2015; 24: 1961-1968
- Thromboembolic events, bleeding, and drug discontinuation in patients with atrial fibrillation on anticoagulation: a prospective hospital-based registry.BMC Cardiovasc Disord. 2016; 16: 254
- Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk.Ann Intern Med. 2004; 141: 413-420
- Glycemia (hemoglobin A1c) and incident venous thromboembolism in the atherosclerosis risk in communities cohort study.Vasc Med. 2013; 18: 245-250
- Hyperglycemia, assessed according to HbA1c, and future risk of venous thromboembolism: the Tromsø study.J Thromb Haemost. 2014; 12: 313-319
- Comparison of MDRD, CKD-EPI, and Cockcroft-Gault equation in relation to measured glomerular filtration rate among a large cohort with diabetes.J Diabetes Complications. 2017; 31: 1376-1383
- Hypoglycemia, cardiovascular outcomes, and death: the LEADER experience.Diabetes Care. 2018 Jun; 14
Article info
Publication history
Published online: August 09, 2018
Accepted:
August 2,
2018
Received in revised form:
June 30,
2018
Received:
April 6,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
