Natural history of patients with venous thromboembolism and hereditary hemorrhagic telangiectasia. Findings from the RIETE registry

Antoni Riera-Mestre, José María Mora-Luján, Javier Trujillo-Santos, Jorge Del Toro, José Antonio Nieto, José María Pedrajas, Raquel López-Reyes, Silvia Soler, Aitor Ballaz, Pau Cerdà, Manel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge-Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio ReisMarijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Joseph A. Caprini, Hanh My Bui, M. D. Adarraga, M. Agud, M. A. Aibar, M. Alcalde-Manero, J. Alfonso, C. Amado, J. I. Arcelus, A. Ballaz, R. Barba, C. Barbagelata, M. Barrón, B. Barrón-Andrés, A. Blanco-Molina, A. M. Camon, I. Cañas, J. Castro, P. Cerdà, J. De Miguel, Jorge Del Toro, P. Demelo, C. Díaz-Pedroche, J. A. Díaz-Peromingo, I. M. Domínguez, J. C. Escribano, C. Falgá, C. Fernández-Capitán, M. C. Fernández-Criado, M. A. Fidalgo, K. Flores, C. Font, L. Font, I. Furest, M. A. García, F. García-Bragado, A. García-Raso, O. Gavín-Blanco, O. Gavín-Sebastián, A. Gil-Díaz, D. Godoy-Díaz, V. Gómez, C. Gómez-Cuervo, J. González-Martínez, E. Grau, L. Guirado, J. Gutiérrez, L. M. Hernández-Blasco, L. Jara-Palomares, M. J. Jaras, D. Jiménez, M. D. Joya, I. Jou, A. Lalueza, R. Lecumberri, J. Lima, P. Llamas, J. L. Lobo, L. López-Jiménez, M. López-Meseguer, P. López-Miguel, J. J. López-Núñez, R. López-Reyes, J. B. López-Sáez, M. A. Lorente, M. Loring, M. Lumbierres, O. Madridano, A. Maestre, P. J. Marchena, F. Martín-Martos, C. Martínez-Baquerizo, M. A. Martínez-García, M. Mellado, J. Moisés

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Abstract

© 2019 The Author(s). Background: Limited data exist about the clinical presentation, ideal therapy and outcomes of patients with hereditary hemorrhagic telangiectasia (HHT) who develop venous thromboembolism (VTE). Methods: We used the data in the RIETE Registry to assess the clinical characteristics, therapeutic approaches and clinical outcomes during the course of anticoagulant therapy in patients with HHT according to initial presentation as pulmonary embolism (PE) or deep venous thrombosis (DVT). Results: Of 51,375 patients with acute VTE enrolled in RIETE from February 2009 to January 2019, 23 (0.04%) had HHT: 14 (61%) initially presented with PE and 9 (39%) with DVT alone. Almost half (47.8%) of the patients with VTE had a risk factor for VTE. Most PE and DVT patients received low-molecular-weight heparin for initial (71 and 100%, respectively) and long-term therapy (54 and 67%, respectively). During anticoagulation for VTE, the rate of bleeding events (major 2, non-major 6) far outweighed the rate of VTE recurrences (recurrent DVT 1): 50.1 bleeds per 100 patient-years (95%CI: 21.6-98.7) vs. 6.26 recurrences (95%CI: 0.31-30.9; p = 0.020). One major and three non-major bleeding were epistaxis. No patient died of bleeding. One patient died shortly after being diagnosed with acute PE. Conclusions: During anticoagulation for VTE in HHT patients, there were more bleeding events than VTE recurrences. Most bleeding episodes were non-major epistaxis.
Original languageEnglish
Article number196
Pages (from-to)196
Number of pages8
JournalOrphanet Journal of Rare Diseases
Volume14
Issue number1
DOIs
Publication statusPublished - 9 Aug 2019

Keywords

  • Deep venous thrombosis
  • EPISTAXIS
  • FACTOR-VIII
  • HHT
  • Hemorrhagic hereditary telangiectasia
  • OUTCOMES
  • Pulmonary embolism
  • RENDU-OSLER-WEBER
  • Rare diseases
  • THERAPY
  • Venous thromboembolism

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    Riera-Mestre, A., Mora-Luján, J. M., Trujillo-Santos, J., Del Toro, J., Nieto, J. A., Pedrajas, J. M., López-Reyes, R., Soler, S., Ballaz, A., Cerdà, P., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., ... Moisés, J. (2019). Natural history of patients with venous thromboembolism and hereditary hemorrhagic telangiectasia. Findings from the RIETE registry. Orphanet Journal of Rare Diseases, 14(1), 196. [196]. https://doi.org/10.1186/s13023-019-1172-8