Influence of body mass index on clinical outcomes in venous thromboembolism: Insights from GARFIELD‐VTE

Background There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE). Objectives Investigate the influence of BMI on baseline characteristics, treatment patterns, and 24‐month outcomes in VTE patients. Methods GARFIELD‐V...

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Published in:	Journal of thrombosis and haemostasis Vol. 19; no. 12; pp. 3031 - 3043
Main Authors:	Weitz, Jeffrey I., Farjat, Alfredo E., Ageno, Walter, Turpie, Alexander G. G., Haas, Sylvia, Goto, Shinya, Goldhaber, Samuel Z., Angchaisuksiri, Pantep, Gibbs, Harry, MacCallum, Peter, Carrier, Marc, Kayani, Gloria, Schellong, Sebastian, Bounameaux, Henri, Mantovani, Lorenzo G., Prandoni, Paolo, Kakkar, Ajay K.
Format:	Journal Article
Language:	English
Published:	England Elsevier Limited 01.12.2021
Subjects:	Anticoagulants - therapeutic use anticoagulation Bleeding Body Mass Index Body weight Clinical outcomes Hemorrhage Humans Mortality Non-pharmacological intervention Obesity Overweight Patients Prospective Studies pulmonary embolism Pulmonary embolisms Thromboembolism Underweight venous thromboembolism Venous Thromboembolism - diagnosis pulmonary embolism body mass index venous thromboembolism obesity anticoagulation
ISSN:	1538-7933, 1538-7836, 1538-7836
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Abstract	Background There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE). Objectives Investigate the influence of BMI on baseline characteristics, treatment patterns, and 24‐month outcomes in VTE patients. Methods GARFIELD‐VTE is a prospective, non‐interventional study of 10 869 patients with objectively confirmed VTE. Patients were grouped according to BMI: <18.5 (underweight; n = 214); 18.5–24.9 (normal; n = 2866); 25.0–29.9 (overweight; n = 3326); ≥30 (obese; n = 3073). Results Compared with patients with a normal BMI, obese patients were more frequently Caucasian (77.4% vs. 57.9%), treated in the outpatient setting (30.4% vs. 23.1%), and had previous VTE (17.5% vs. 11.7%). Active cancer was associated with lower BMI (underweight: 30.4%, normal: 13.5%, overweight: 9.4%, obese: 7.0%). At baseline, overweight and obese patients less often received parenteral therapy alone (16.7% and 14.4%) compared with those with an underweight or normal BMI (30.8% and 21.6%). Obese patients more commonly remained on anticoagulants for ≥2‐years compared to those with a normal BMI (52.3% vs. 37.7%). After 24‐months, the risk of all‐cause mortality was lower in overweight and obese patients than in those with normal BMI (adjusted hazard ratio [95% CI]; 0.75 [0.63–0.89] and 0.59 [0.49–0.72], respectively). Underweight patients more often experienced major bleeding (2.45 [1.41–4.26]) and all‐cause mortality (1.90 [1.43–2.53]) than patients with a normal BMI. Recurrent VTE was comparable among groups. Conclusion Underweight VTE patients have the highest risk of mortality and major bleeding. The risk of mortality in obese VTE patients is lower than that in VTE patients with a normal BMI.
AbstractList	There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE). Investigate the influence of BMI on baseline characteristics, treatment patterns, and 24-month outcomes in VTE patients. GARFIELD-VTE is a prospective, non-interventional study of 10 869 patients with objectively confirmed VTE. Patients were grouped according to BMI: <18.5 (underweight; n = 214); 18.5-24.9 (normal; n = 2866); 25.0-29.9 (overweight; n = 3326); ≥30 (obese; n = 3073). Compared with patients with a normal BMI, obese patients were more frequently Caucasian (77.4% vs. 57.9%), treated in the outpatient setting (30.4% vs. 23.1%), and had previous VTE (17.5% vs. 11.7%). Active cancer was associated with lower BMI (underweight: 30.4%, normal: 13.5%, overweight: 9.4%, obese: 7.0%). At baseline, overweight and obese patients less often received parenteral therapy alone (16.7% and 14.4%) compared with those with an underweight or normal BMI (30.8% and 21.6%). Obese patients more commonly remained on anticoagulants for ≥2-years compared to those with a normal BMI (52.3% vs. 37.7%). After 24-months, the risk of all-cause mortality was lower in overweight and obese patients than in those with normal BMI (adjusted hazard ratio [95% CI]; 0.75 [0.63-0.89] and 0.59 [0.49-0.72], respectively). Underweight patients more often experienced major bleeding (2.45 [1.41-4.26]) and all-cause mortality (1.90 [1.43-2.53]) than patients with a normal BMI. Recurrent VTE was comparable among groups. Underweight VTE patients have the highest risk of mortality and major bleeding. The risk of mortality in obese VTE patients is lower than that in VTE patients with a normal BMI. There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE).BACKGROUNDThere is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE).Investigate the influence of BMI on baseline characteristics, treatment patterns, and 24-month outcomes in VTE patients.OBJECTIVESInvestigate the influence of BMI on baseline characteristics, treatment patterns, and 24-month outcomes in VTE patients.GARFIELD-VTE is a prospective, non-interventional study of 10 869 patients with objectively confirmed VTE. Patients were grouped according to BMI: <18.5 (underweight; n = 214); 18.5-24.9 (normal; n = 2866); 25.0-29.9 (overweight; n = 3326); ≥30 (obese; n = 3073).METHODSGARFIELD-VTE is a prospective, non-interventional study of 10 869 patients with objectively confirmed VTE. Patients were grouped according to BMI: <18.5 (underweight; n = 214); 18.5-24.9 (normal; n = 2866); 25.0-29.9 (overweight; n = 3326); ≥30 (obese; n = 3073).Compared with patients with a normal BMI, obese patients were more frequently Caucasian (77.4% vs. 57.9%), treated in the outpatient setting (30.4% vs. 23.1%), and had previous VTE (17.5% vs. 11.7%). Active cancer was associated with lower BMI (underweight: 30.4%, normal: 13.5%, overweight: 9.4%, obese: 7.0%). At baseline, overweight and obese patients less often received parenteral therapy alone (16.7% and 14.4%) compared with those with an underweight or normal BMI (30.8% and 21.6%). Obese patients more commonly remained on anticoagulants for ≥2-years compared to those with a normal BMI (52.3% vs. 37.7%). After 24-months, the risk of all-cause mortality was lower in overweight and obese patients than in those with normal BMI (adjusted hazard ratio [95% CI]; 0.75 [0.63-0.89] and 0.59 [0.49-0.72], respectively). Underweight patients more often experienced major bleeding (2.45 [1.41-4.26]) and all-cause mortality (1.90 [1.43-2.53]) than patients with a normal BMI. Recurrent VTE was comparable among groups.RESULTSCompared with patients with a normal BMI, obese patients were more frequently Caucasian (77.4% vs. 57.9%), treated in the outpatient setting (30.4% vs. 23.1%), and had previous VTE (17.5% vs. 11.7%). Active cancer was associated with lower BMI (underweight: 30.4%, normal: 13.5%, overweight: 9.4%, obese: 7.0%). At baseline, overweight and obese patients less often received parenteral therapy alone (16.7% and 14.4%) compared with those with an underweight or normal BMI (30.8% and 21.6%). Obese patients more commonly remained on anticoagulants for ≥2-years compared to those with a normal BMI (52.3% vs. 37.7%). After 24-months, the risk of all-cause mortality was lower in overweight and obese patients than in those with normal BMI (adjusted hazard ratio [95% CI]; 0.75 [0.63-0.89] and 0.59 [0.49-0.72], respectively). Underweight patients more often experienced major bleeding (2.45 [1.41-4.26]) and all-cause mortality (1.90 [1.43-2.53]) than patients with a normal BMI. Recurrent VTE was comparable among groups.Underweight VTE patients have the highest risk of mortality and major bleeding. The risk of mortality in obese VTE patients is lower than that in VTE patients with a normal BMI.CONCLUSIONUnderweight VTE patients have the highest risk of mortality and major bleeding. The risk of mortality in obese VTE patients is lower than that in VTE patients with a normal BMI. BackgroundThere is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE).ObjectivesInvestigate the influence of BMI on baseline characteristics, treatment patterns, and 24‐month outcomes in VTE patients.MethodsGARFIELD‐VTE is a prospective, non‐interventional study of 10 869 patients with objectively confirmed VTE. Patients were grouped according to BMI: <18.5 (underweight; n = 214); 18.5–24.9 (normal; n = 2866); 25.0–29.9 (overweight; n = 3326); ≥30 (obese; n = 3073).ResultsCompared with patients with a normal BMI, obese patients were more frequently Caucasian (77.4% vs. 57.9%), treated in the outpatient setting (30.4% vs. 23.1%), and had previous VTE (17.5% vs. 11.7%). Active cancer was associated with lower BMI (underweight: 30.4%, normal: 13.5%, overweight: 9.4%, obese: 7.0%). At baseline, overweight and obese patients less often received parenteral therapy alone (16.7% and 14.4%) compared with those with an underweight or normal BMI (30.8% and 21.6%). Obese patients more commonly remained on anticoagulants for ≥2‐years compared to those with a normal BMI (52.3% vs. 37.7%). After 24‐months, the risk of all‐cause mortality was lower in overweight and obese patients than in those with normal BMI (adjusted hazard ratio [95% CI]; 0.75 [0.63–0.89] and 0.59 [0.49–0.72], respectively). Underweight patients more often experienced major bleeding (2.45 [1.41–4.26]) and all‐cause mortality (1.90 [1.43–2.53]) than patients with a normal BMI. Recurrent VTE was comparable among groups.ConclusionUnderweight VTE patients have the highest risk of mortality and major bleeding. The risk of mortality in obese VTE patients is lower than that in VTE patients with a normal BMI. Background There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE). Objectives Investigate the influence of BMI on baseline characteristics, treatment patterns, and 24‐month outcomes in VTE patients. Methods GARFIELD‐VTE is a prospective, non‐interventional study of 10 869 patients with objectively confirmed VTE. Patients were grouped according to BMI: <18.5 (underweight; n = 214); 18.5–24.9 (normal; n = 2866); 25.0–29.9 (overweight; n = 3326); ≥30 (obese; n = 3073). Results Compared with patients with a normal BMI, obese patients were more frequently Caucasian (77.4% vs. 57.9%), treated in the outpatient setting (30.4% vs. 23.1%), and had previous VTE (17.5% vs. 11.7%). Active cancer was associated with lower BMI (underweight: 30.4%, normal: 13.5%, overweight: 9.4%, obese: 7.0%). At baseline, overweight and obese patients less often received parenteral therapy alone (16.7% and 14.4%) compared with those with an underweight or normal BMI (30.8% and 21.6%). Obese patients more commonly remained on anticoagulants for ≥2‐years compared to those with a normal BMI (52.3% vs. 37.7%). After 24‐months, the risk of all‐cause mortality was lower in overweight and obese patients than in those with normal BMI (adjusted hazard ratio [95% CI]; 0.75 [0.63–0.89] and 0.59 [0.49–0.72], respectively). Underweight patients more often experienced major bleeding (2.45 [1.41–4.26]) and all‐cause mortality (1.90 [1.43–2.53]) than patients with a normal BMI. Recurrent VTE was comparable among groups. Conclusion Underweight VTE patients have the highest risk of mortality and major bleeding. The risk of mortality in obese VTE patients is lower than that in VTE patients with a normal BMI.
Author	Carrier, Marc Gibbs, Harry Mantovani, Lorenzo G. Turpie, Alexander G. G. Kayani, Gloria Farjat, Alfredo E. Haas, Sylvia Schellong, Sebastian Goto, Shinya MacCallum, Peter Kakkar, Ajay K. Angchaisuksiri, Pantep Prandoni, Paolo Weitz, Jeffrey I. Goldhaber, Samuel Z. Ageno, Walter Bounameaux, Henri
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Notes	Manuscript handled by: Jean Connors Funding information This work was supported by KANTOR CHARITABLE FOUNDATION for the Kantor‐Kakkar Global Centre for Thrombosis Science. A complete list of investigators is given in the Supplemental material . ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
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Snippet	Background There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE).... There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE). Investigate the... BackgroundThere is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism... There is limited information on the influence of body mass index (BMI) on clinical outcomes in patients with venous thromboembolism (VTE).BACKGROUNDThere is...
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SubjectTerms	Anticoagulants - therapeutic use anticoagulation Bleeding Body Mass Index Body weight Clinical outcomes Hemorrhage Humans Mortality Non-pharmacological intervention Obesity Overweight Patients Prospective Studies pulmonary embolism Pulmonary embolisms Thromboembolism Underweight venous thromboembolism Venous Thromboembolism - diagnosis
Title	Influence of body mass index on clinical outcomes in venous thromboembolism: Insights from GARFIELD‐VTE
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