High gas6 in plasma predicts venous thromboembolism recurrence, major bleeding and mortality in the elderly.

Schnegg-Kaufmann, A; Calzavarini, S; Limacher, A; Mean, M; Righini, M; Staub, D; Beer, J H; Frauchiger, B; Osterwalder, J; Kucher, N; Matter, C M; Husmann, M; Banyai, M; Aschwanden, M; Mazzolai, L; Hugli, O; Nagler, M; Daskalakis, M; Rodondi, N; Aujesky, D; ... (2019). High gas6 in plasma predicts venous thromboembolism recurrence, major bleeding and mortality in the elderly. Journal of thrombosis and haemostasis, 17(2), pp. 306-318. Wiley-Blackwell 10.1111/jth.14365

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BACKGROUND

Growth arrest-specific gene 6 (Gas6) is a pro-hemostatic protein with an unknown predictive ability for recurrent venous thromboembolism (VTE). In the elderly, VTE carries a higher mortality but not a higher rate of VTE recurrence than in younger patients. Consequently, anticoagulation management in the elderly is challenging.

OBJECTIVE

To prospectively investigate the performance of Gas6 to predict VTE recurrence, major bleeding and mortality in the elderly.

METHODS

Consecutive patients aged ≥65 with acute VTE were followed over 3 years. Primary outcomes were symptomatic VTE recurrence, major bleeding and mortality. Plasmatic Gas6 was measured by ELISA.

RESULTS

Gas6 was measured in 864 patients at the time of the index VTE (T1) and in 70% of them, also 12 months later (T2). Gas6 at T1 was discriminatory for VTE recurrence (C-statistics: 0.56, 95% confidence interval [CI]: 0.51 to 0.62), major bleeding (0.60, 95%CI: 0.55 to 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 Gas6 at T2 (0.62, 95%CI: 0.54-0.71). High Gas6 (>157%) and continuous Gas6 levels at T1 were associated with VTE recurrence up to 6 and 12 months, respectively.

CONCLUSIONS

In elderly patients, high Gas6 is associated with a higher risk of VTE recurrence, major bleeding and death. These findings support urther studies to assess the performance of Gas6 for adjusting anticoagulation length. This article is protected by copyright. All rights reserved.

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