Hemostatic and inflammatory biomarkers are associated with functional limitations after venous thromboembolism: A prospective cohort study.

Abstract

Functional limitations often persist in patients with venous thromboembolism (VTE). The relevance of biomarkers for these outcomes remains unexplored. Therefore, we aimed to investigate the association of hemostatic, inflammatory, and cardiovascular biomarkers with functional limitations three months after VTE. We conducted a prospective cohort study, including patients with acute VTE within 21 days of diagnosis. Biomarkers levels (D-dimer, fibrinogen, factor VIII (FVIII), von Willebrand factor antigen (VWF), C-reactive protein (CRP), troponin T, N-terminal pro b-type natriuretic peptide (proBNP)) were measured at inclusion and three months. Functional limitations at three months were evaluated with the post-VTE functional status scale (0-4, higher indicating more limitations). The association of biomarkers with functional limitations was assessed with proportional odds models adjusted for confounders. Furthermore, we evaluated the AUC-ROC for the presence of slight-to-severe functional limitations. Overall, we included 290 patients (41.4% women) with a median age of 54.9 years (IQR: 43.1-64.2). D-dimer, fibrinogen, FVIII, VWF, and CRP measured at inclusion were independently associated with functional limitations at three months. VWF showed the most favorable AUC-ROC (0.62, 95%CI, 0.55-0.69). In patients with pulmonary embolism, troponin T and proBNP were not associated with functional limitations. At three-month follow-up, D-dimer was the only biomarker independently associated with functional limitations, yielding an AUC of 0.62 (96%CI, 0.55-0.69). In conclusion, we identified biomarkers independently associated with functional limitations three months after VTE. Our results indicate a role of these biomarkers in early identification of patients at risk of persistent functional limitations and suggest their involvement in the underlying mechanisms.