A high Gas6 level in plasma predicts venous thromboembolism recurrence, major bleeding and mortality in the elderly: a prospective multicenter cohort study
Author(s): ,
Annatina Schnegg‐Kaufmann
Affiliations:
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Department for BioMedical Research, University of Bern, Bern, Switzerland
,
Sara Calzavarini
Affiliations:
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Department for BioMedical Research, University of Bern, Bern, Switzerland
,
Andreas Limacher
Affiliations:
CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
,
Marie Mean
Affiliations:
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
,
Marc Righini
Affiliations:
Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
,
Daniel Staub
Affiliations:
Division of Angiology, Basel University Hospital, Basel, Switzerland
,
Juerg‐Hans Beer
Affiliations:
Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
,
Beat Frauchiger
Affiliations:
Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland
,
Joseph Osterwalder
Affiliations:
Cantonal Hospital of St Gallen, Gallen, Switzerland
,
Nils Kucher
Affiliations:
University Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Christian M. Matter
Affiliations:
Center for Molecular Cardiology, University of Zurich, and Clinic for Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
,
Marc Husmann
Affiliations:
University Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Martin Banyai
Affiliations:
Division of Angiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
,
Markus Aschwanden
Affiliations:
Division of Angiology, Basel University Hospital, Basel, Switzerland
,
Lucia Mazzolai
Affiliations:
Service of Angiology, Lausanne University Hospital, Lausanne, Switzerland
,
Oliver Hugli
Affiliations:
Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
,
Michael Nagler
Affiliations:
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Department for BioMedical Research, University of Bern, Bern, Switzerland
,
Michael Daskalakis
Affiliations:
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Department for BioMedical Research, University of Bern, Bern, Switzerland
,
Nicolas Rodondi
Affiliations:
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
,
Drahomir Aujesky
Affiliations:
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Anne Angelillo‐Scherrer
Affiliations:
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Department for BioMedical Research, University of Bern, Bern, Switzerland
Correspondence: Anne Angelillo‐Scherrer, Department of Hematology and Central Hematology Laboratory, Inselspitalm, Bern University Hospital, University of Bern, CH‐3010 Bern, Switzerland|Tel.: +41 31 632 3302|E‐mail: anne.angelillo-scherrer@insel
ISTH Academy. Angelillo- Scherrer A. Feb 8, 2019; 273374
Anne Angelillo- Scherrer
Anne Angelillo- Scherrer
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Background
Growth arrest‐specific gene 6 (Gas6) is a prohemostatic protein with an unknown predictive ability for recurrent venous thromboembolism (VTE). In the elderly, VTE results in higher mortality but does not have a higher rate of recurrence than in younger patients. Consequently, anticoagulation management in the elderly is challenging.
Objective
To prospectively investigate the performance of Gas6 in predicting VTE recurrence, major bleeding and mortality in the elderly.
Methods
Consecutive patients aged ≥ 65 years with acute VTE were followed for a period of 3 years. Primary outcomes were symptomatic VTE recurrence, major bleeding, and mortality. Plasma Gas6 was measured with ELISA.
Results
Gas6 levels were measured in 864 patients at the time of the index VTE (T1) and, in 70% of them, also 12 months later (T2). The Gas6 level at T1 was discriminatory for VTE recurrence (C‐statistic, 0.56; 95% confidence interval [CI] 0.51–0.62), major bleeding (0.60, 95% CI 0.55–0.65) and mortality (0.69, 95% CI 0.65–0.73) up to 36 months. VTE recurrence up to 24 months after T2 was discriminated by the Gas6 level at T2 (0.62, 95% CI 0.54–0.71). High Gas6 levels (> 157%) and continuous Gas6 levels at T1 were associated with VTE recurrence up to 6 months and 12 months, respectively.
Conclusions
In elderly patients, a high Gas6 level is associated with higher risks of VTE recurrence, major bleeding, and death. These findings support further studies to assess the performance of Gas6 in adjusting the length of anticoagulation.
Keyword(s)
aged, cohort studies, growth arrest‐specific gene 6, mortality, venous thromboembolism
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