Racial disparities in the incidence and risk factors of major bleeding during extended anticoagulant therapy for venous thromboembolism.

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-08-05 DOI:10.1016/j.jtha.2025.07.026

Duale Omar, Michael J Kovacs, Alejandro Lazo-Langner, David R Anderson, Susan R Kahn, Lana A Castellucci, Jeannot Schmidt, Antoine Elias, Marc Righini, Thomas L Ortel, Menno V Huisman, Marc Carrier, Jude-Mary Cénat, Ranjeeta Mallick, Marc A Rodger, Grégoire Le Gal, Philip S Wells, Yan Xu

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引用次数: 0

Abstract

Background: Guidelines recommend extended anticoagulation after a first unprovoked venous thromboembolism (VTE) for individuals at low risk of bleeding. However, racial disparities in bleeding risks during extended treatment remain understudied.

Objectives: To compare risks of anticoagulant-associated bleeding and performance of a risk assessment model by racial group during extended VTE treatment.

Methods: We analyzed 2 prospective cohorts of patients (223 Black participants and 4314 White participants) with a first unprovoked/weakly provoked VTE who continued anticoagulation after ≥3 months of initial treatment. Primary outcome was adjudicated International Society on Thrombosis and Haemostasis-defined major bleeding. Secondary outcomes included intracranial hemorrhage, fatal bleeding, and clinically relevant nonmajor bleeding. We determined incidence and hazard ratios (HRs) by race, then adjusted for bleeding risk factors that included the Creatinine, Hemoglobin, Age, antiPlatelet model.

Results: Black participants had higher prevalence of bleeding risk factors and a 1.9-fold higher risk of major bleeding (HR, 1.87; 95% CI, 1.04-3.36) compared with White participants. Adjustment attenuated racial difference for major bleeding but not intracranial hemorrhage (adjusted HR, 2.35; 95% CI, 1.23-4.48). Among those classified as low risk by Creatinine, Hemoglobin, Age, antiPlatelet model, Black participants had numerically higher major bleeding incidence than White participants (2.5 vs 1.1 per 100 person-years). We did not observe racial disparities in fatal bleeding or clinically relevant nonmajor bleeding.

Conclusion: Black individuals on extended anticoagulation have higher risk of major bleeding compared with White individuals. This effect appears to persist in those classified as low risk for bleeding. Risk assessment models for anticoagulant-associated bleeding that are generalizable to racialized populations are needed.

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静脉血栓栓塞延长抗凝治疗期间大出血发生率和危险因素的种族差异。

背景：指南推荐在低出血风险个体中首次无因性静脉血栓栓塞（VTE）后延长抗凝时间。然而，长期治疗期间出血风险的种族差异仍未得到充分研究。目的：比较不同种族在静脉血栓栓塞治疗期间抗凝相关出血的风险和风险评估模型（RAM）的表现。方法：我们分析了两个前瞻性队列（223名黑人参与者和4314名白人参与者），首次无诱发性/弱诱发性静脉血栓栓塞患者在初始治疗≥3个月后继续抗凝治疗。主要结局是国际血栓和止血学会判定的大出血。次要结局包括颅内出血（ICH）、致命性出血和临床相关的非大出血（CRNMB）。我们按种族确定发生率和危险比（hr），然后调整出血危险因素，包括CHAP（肌酐、血红蛋白、年龄、抗血小板）模型。结果：与白人受试者相比，黑人受试者出血危险因素患病率更高，大出血风险高1.9倍（HR 1.87, 95% CI 1.04-3.36）。调整降低了大出血而非脑出血的种族差异（调整后HR 2.35, 95% CI 1.23-4.48）。在被CHAP分类为低风险的人群中，黑人参与者的大出血发生率高于白人参与者（2.5 vs 1.1 / 100人年）。我们没有观察到致命性出血或crnmb的种族差异。结论：延长抗凝治疗的黑人大出血风险高于白人。这种影响似乎在那些被归类为低出血风险的人群中持续存在。需要适用于种族化人群的抗凝相关出血RAMs。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.