SERAFINO MANSUETO AWARD | Low-density lipoprotein cholesterol levels and bleeding during anticoagulation for venous hromboembolism

C. Siniscalchi¹, T. Meschi¹, P. Di Micco², E. Imbalzano³, L. Hernandez-Blasco⁴, J.L. Fernandez-Reyes⁵, A. Garcia-Ortega⁶, P. Verhamme⁷, J. Alfonso-Megido⁸, M. Monreal⁹ | ¹Department of Internal Medicine, Parma University Hospital, Parma, Italy; ²AFO Medicina PO Santa Maria delle Grazie, Pozzuoli Naples Hospital 2 Nord; Naples, Italy; ³Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Italy; ⁴Pneumology Department of Clinical Medicine, Miguel Hernández University, ISABIAL, Dr. Balmis University General Hospital, Alicante, Spain; ⁵Department of Internal Medicine, Complejo Hospitalario de Jaén, Spain; ⁶Department of Pneumonology, Hospital Universitario Doctor Peset, Valencia, Spain; ⁷Vascular Medicine and Haemostasis, University of Leuven, Belgium; ⁸Hospital Valle del Nalón, Department of Internal Medicine, Langreo, Asturias, Spain; ⁹Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM, Universidad Católica San Antonio de Murcia, Spain. CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

Premises and Purpose of the study: The association between low-density lipoprotein cholesterol (LDL-C) levels and bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been previously explored. While low LDL-C levels are beneficial for reducing cardiovascular events, their impact on bleeding risk in VTE patients remains uncertain.
Materials and Methods: This observational prospective case-control study utilized data from the Registro RIETE. Enrolled patients have a follow up of 90-days. All patients with objectively documented acute deep vein thrombosis (DVT) or pulmonary embolism (PE) are recruited. We aimed to assess the influence of baseline LDL-C levels on bleeding risk during the first 90 days of anticoagulation in 19,237 VTE patients. Multivariable analyses were conducted to evaluate the association between LDL-C levels (<70 mg/dL vs ≥70 mg/dL) and bleeding outcomes.
Results: Of 19,237 patients, 2,502 (13.0%) had LDL-C levels <70 mg/dL. During the first 90 days, 743 patients (3.9%) experienced bleeding events (294 major bleeding, 449 non-major bleeding, 32 fatal bleeding). On multivariable analysis, LDL-C levels <70 mg/dL were associated with a higher risk of overall bleeding (adjusted hazard ratio [aHR]: 1.44; 95%CI: 1.19-1.74). The heightened bleeding risk appeared early in treatment and was primarily linked to hematoma formation (aHR: 2.11; 95%CI: 1.49-2.98).
Conclusions: In VTE patients receiving anticoagulation, LDL-C levels <70 mg/dL were independently associated with an increased risk of bleeding, particularly hematomas.