Venous Thromboembolism Sequelae in a Population-based Inception Cohort - PROJECT SUMMARY / ABSTRACT Nearly 1 million Americans each year experience a first venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is typically viewed as an acute event that is treatable by anticoagulants, with less focus on chronic adverse VTE sequelae or on rehabilitation. Adults who have experienced an incident VTE may be at high risk for adverse VTE sequelae in the first 12 months after their event, including patient-relevant symptoms (such as dyspnea, pain, and swelling) and adverse clinical outcomes (VTE recurrence and death). Research to-date has characterized the post-thrombotic syndrome occurring post-DVT, but there has been much less attention given to sequelae following an incident PE. Furthermore, almost all research about sequelae after both DVT and PE has been in the context of anticoagulation with vitamin K antagonists rather than with newer direct oral anticoagulants (DOACs), which are now primarily used in practice. Clinically, we lack methods to identify adults at greatest risk of adverse VTE sequelae and how to prevent these sequelae. Whether several promising biomarkers that are readily available for clinical measurement (brain natriuretic peptide, D-dimer, and troponin), or, whether modifiable exposures such as anticoagulant type or physical activity are associated with adverse VTE sequelae is incompletely understood. In the proposed research, we will characterize patient-relevant symptoms and adverse clinical outcomes at multiple timepoints in the first 12 months post-VTE and will evaluate biomarkers and modifiable risk factors in relation to these VTE sequelae. To accomplish this, we will create a new prospective population- based inception cohort study based in Kaiser Permanente Washington, an integrated healthcare delivery system in Washington State. Our preliminary research supports the feasibility of daily identification of incident VTE cases among adult enrollees, and we anticipate ~957 eligible adults with validated VTE across 33 months of enrollment. De novo data collection in ~380 consenting adults will include: 1) surveys at 2 weeks and 1, 3, 6, and 12 months post-VTE to collect information on post-VTE symptoms, 2) wrist-worn accelerometers to objectively measure physical activity and resting heart rate in the 12 months post-VTE, and 3) blood collection within 4 weeks of the incident VTE to measure 3 pre-specified biomarkers. These study data will be combined with rich electronic health record data to accomplish 3 scientific aims: (1) Characterize the prevalence pattern of symptoms at 2 weeks and 1, 3, 6, and 12 months post-incident VTE and clinical outcomes over the 12 months of follow-up; (2) evaluate the associations of key biomarker levels measured in blood collected within 4 weeks of the incident VTE; and, (3) evaluate modifiable risk factors for sequalae, including VTE anticoagulant type and physical activity level. This research will fill critical knowledge gaps that are important to patients by providing estimates of the prevalence of clinically burdensome VTE sequelae and identifying possible etiologic and modifiable risk factors that can be targeted in future interventions.
