Thrombin Generation to Predict the Risk of Venous Thromboembolism Recurrence, Major Bleeding and Death in the Elderly: A Prospective Multicenter Cohort Study

Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), constitutes a worldwide major health issue, and a leading cause of death. VTE incidence increases exponentially with age mainly due to the accumulation of risk factors and comorbidities predisposing to thrombosis. This leads to greater morbidity impact of VTE on elderly patients, who are also at higher risk of bleeding. Consequently, identification of older patients who might benefit from indefinite anticoagulation treatment is paramount. In order to facilitate the identification of these patients, the benefit/risk ratio should be carefully evaluated by considering clinical and laboratory information. Thrombin activity can be recorded by continuously measuring cleavage of a fluorescent substrate, resulting in a thrombin generation (TG) curve. Recent association studies show promising data of thrombin generation parameters predicting first VTE in elderly (Wang H et. al. RPTH 2021, 5:e12536). However, the predictive ability of thrombin generation for recurrent VTE, major bleeding and mortality in the elderly is unknown. The goal of this study was to prospectively investigate the performance of the TG assay one year after index VTE in predicting the risk of VTE, recurrence, major bleeding and mortality up to 2 years in elderly population.