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

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.