1
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May JE, Moll S. How I treat the co-occurrence of venous and arterial thromboembolism: anticoagulation, antiplatelet therapy, or both? Blood 2024; 143:2351-2362. [PMID: 38364188 DOI: 10.1182/blood.2023021638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
ABSTRACT Arterial and venous thromboses are classically considered distinct disease states, with arterial thrombosis mediated predominantly by platelets and therefore, treated with antiplatelet therapy, and venous thrombosis mediated by the plasmatic coagulation system and treated with anticoagulation. However, co-occurrence of arterial and venous events is common, and there is increasing evidence of shared risk factors and pathophysiologic overlap. This presents a management challenge: does the patient with venous and arterial thrombosis, require anticoagulation, antiplatelet therapy, or both? Herein, we present a structured approach to the evaluation and management of patients with venous thrombosis who are also at risk for or have a history of an arterial thromboembolic event. We emphasize the importance of defining the indications for antithrombotic therapy, as well as the evaluation of factors that influence both thrombotic and bleeding risk, including disorder-specific and patient-specific factors, as well as the inherent risk balance of antithrombotic therapy regimens. We illustrate this approach in 4 cases, discussing the unique considerations and recent updates in the management of venous thrombosis, acute noncardioembolic ischemic stroke, coronary artery disease and acute myocardial infarction, and peripheral artery disease after revascularization.
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Affiliation(s)
- Jori E May
- Division of Hematology/Oncology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Stephan Moll
- Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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2
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Ahrén J, Pirouzifard M, Holmquist B, Sundquist J, Sundquist K, Zöller B. Multimorbidity disease clusters are associated with venous thromboembolism: an extended cross-sectional national study. J Thromb Thrombolysis 2024:10.1007/s11239-024-02987-y. [PMID: 38678153 DOI: 10.1007/s11239-024-02987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
Multimorbidity, i.e., two or more non-communicable diseases (NCDs), is an escalating challenge for society. Venous thromboembolism (VTE) is a common cardiovascular disease and it is unknown which multimorbidity clusters associates with VTE. Our aim was to examine the association between different common disease clusters of multimorbidity and VTE. The study is an extended (1997-2015) cross-sectional Swedish study using the National Patient Register and the Multigeneration Register. A total of 2,694,442 Swedish-born individuals were included in the study. Multimorbidity was defined by 45 NCDs. A principal component analysis (PCA) identified multimorbidity disease clusters. Odds ratios (OR) for VTE were calculated for the different multimorbidity disease clusters. There were 16% (n = 440,742) of multimorbid individuals in the study population. Forty-four of the individual 45 NCDs were associated with VTE. The PCA analysis identified nine multimorbidity disease clusters, F1-F9. Seven of these multimorbidity clusters were associated with VTE. The adjusted OR for VTE in the multimorbid patients was for the first three clusters: F1 (cardiometabolic diseases) 3.44 (95%CI 3.24-3.65), F2 (mental disorders) 2.25 (95%CI 2.14-2.37) and F3 (digestive system diseases) 4.35 (95%CI 3.63-5.22). There was an association between multimorbidity severity and OR for VTE. For instance, the occurrence of at least five diseases was in F1 and F2 associated with ORs for VTE: 8.17 (95%CI 6.32-10.55) and 6.31 (95%CI 4.34-9.17), respectively. In this nationwide study we have shown a strong association between VTE and different multimorbidity disease clusters that might be useful for VTE prediction.
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Affiliation(s)
- Jonatan Ahrén
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
- University Clinic Primary Care Skåne, Region Skåne, Sweden.
| | - MirNabi Pirouzifard
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
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3
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Lonnberg F, Roos A, Farm M, Heurlin A, Okas M, Gigante B, Siddiqui AJ. Causes of death after first time venous thromboembolism. Thromb J 2024; 22:16. [PMID: 38303070 PMCID: PMC10832181 DOI: 10.1186/s12959-024-00586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Causes of death after first time community-acquired venous thromboembolism (VTE) diagnosed in unselected patients at the emergency department (ED) was investigated. MATERIALS AND METHODS The study consists of all patients > 18 years of age who had a visit for any medical reason to any of 5 different ED in Stockholm County, Sweden from 1st January 2016 to 31st December 2017. We have identified all patients with a first registered incident VTE; deep vein thrombosis (DVT) and/or pulmonary embolism (PE) during the study period. Cox regression models were used to estimate hazards ratios (HR) with 95% confidence intervals (CIs) for all-cause mortality and cause-specific death in patients with DVT or PE using all other patients as the reference group. RESULTS In total, 359,884 patients had an ED visit during the study period of whom about 2.1% were diagnosed with VTE (DVT = 4,384, PE = 3,212). The patients with VTE were older compared to the control group. During a mean follow up of 2.1 years, 1567 (21%) and 23,741(6.7%) patients died within the VTE and reference group, respectively. The adjusted risk of all-cause mortality was nearly double in patients with DVT (HR 1.7; 95% CI, 1.5-1.8) and more than 3-fold in patients with PE (HR 3.4; 95% CI, 3.1-3.6). While the risk of cancer related death was nearly 3-fold in patient with DVT (HR 2.7; 95% CI, 2.4-3.1), and 5-fold in PE (HR 5.4; 95% CI, 4.9-6.0 respectively). The diagnosis of PE during the ED visit was associated with a significantly higher risk of cardiovascular death (HR 2.2; 95% CI, 1.9-2.6). CONCLUSION Patients with VTE have an elevated risk of all-cause mortality, including cardiovascular death.
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Affiliation(s)
- Frida Lonnberg
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Roos
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Farm
- Karolinska University, Solna, Sweden
- Karolinska University Hospital, Solna, Sweden
| | - André Heurlin
- Acute Medicine, Capio. St. Görans Hospital, Stockholm, Sweden
| | - Mantas Okas
- Acute Medicine, Capio. St. Görans Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Anwar J Siddiqui
- Department of Medicine, Karolinska Institute, Solna, Sweden.
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
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4
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Yoon D, Jeong HE, Choi S, Lee D, Shin J, Bang S. Heterogeneous distributions in clinical events preceding anticoagulant treatment nonpersistence in patients with venous thromboembolism stratified by active cancer: A nationwide cohort study. Cancer Med 2023; 12:20538-20543. [PMID: 37882319 PMCID: PMC10660092 DOI: 10.1002/cam4.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Nonpersistence in anticoagulation therapy is common and associated with undesirable clinical outcomes in patients with venous thromboembolism (VTE). METHODS We investigated preceding clinical events of treatment nonpersistence (e.g., switching, discontinuing, or restarting) in VTE patients with and without active cancer using Korean claims database. RESULTS Clinically significant events including thromboembolic events, hepatic function change and surgery preceded treatment nonpersistence, but heterogeneous distributions of clinical events were observed in the presence of active cancer. Patients with active cancer had a low rate of clinical events preceding treatment nonpersistence, and new active cancer diagnosis in the nonactive cancer group was most common before the switch to parenteral anticoagulants from warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). CONCLUSION These findings suggest that clinically significant events can precede treatment nonpersistence and largely paralleled current guidelines for patients with VTE, whereas heterogeneous distributions of clinical events were observed in the presence of active cancer.
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Affiliation(s)
- Dongwon Yoon
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Han Eol Jeong
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Songhwa Choi
- Medical AffairsPfizer Korea Ltd.SeoulSouth Korea
| | - Daye Lee
- Medical AffairsPfizer Korea Ltd.SeoulSouth Korea
| | - Ju‐Young Shin
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
- Samsung Advanced Institute for Health Sciences & TechnologySungkyunkwan UniversitySeoulSouth Korea
| | - Soo‐Mee Bang
- Division of Hemato‐Oncology, Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
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5
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Ahrén J, Pirouzifard M, Holmquist B, Sundquist J, Halling A, Sundquist K, Zöller B. A hypothesis - generating Swedish extended national cross-sectional family study of multimorbidity severity and venous thromboembolism. BMJ Open 2023; 13:e072934. [PMID: 37328186 PMCID: PMC10277039 DOI: 10.1136/bmjopen-2023-072934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES Venous thromboembolism (VTE) is a common worldwide disease. The burden of multimorbidity, that is, two or more chronic diseases, has increased. Whether multimorbidity is associated with VTE risk remains to be studied. Our aim was to determine any association between multimorbidity and VTE and any possible shared familial susceptibility. DESIGN A nationwide extended cross-sectional hypothesis - generating family study between 1997 and 2015. SETTING The Swedish Multigeneration Register, the National Patient Register, the Total Population Register and the Swedish cause of death register were linked. PARTICIPANTS 2 694 442 unique individuals were analysed for VTE and multimorbidity. MAIN OUTCOMES AND MEASURES Multimorbidity was determined by a counting method using 45 non-communicable diseases. Multimorbidity was defined by the occurrence of ≥2 diseases. A multimorbidity score was constructed defined by 0, 1, 2, 3, 4 or 5 or more diseases. RESULTS Sixteen percent (n=440 742) of the study population was multimorbid. Of the multimorbid patients, 58% were females. There was an association between multimorbidity and VTE. The adjusted odds ratio (OR) for VTE in individuals with multimorbidity (2 ≥ diagnoses) was 3.16 (95% CI: 3.06 to 3.27) compared with individuals without multimorbidity. There was an association between number of diseases and VTE. The adjusted OR was 1.94 (95% CI: 1.86 to 2.02) for one disease, 2.93 (95% CI: 2.80 to 3.08) for two diseases, 4.07 (95% CI: 3.85 to 4.31) for three diseases, 5.46 (95% CI: 5.10 to 5.85) for four diseases and 9.08 (95% CI: 8.56 to 9.64) for 5 ≥ diseases. The association between multimorbidity and VTE was stronger in males OR 3.45 (3.29 to 3.62) than in females OR 2.91 (2.77 to 3.04). There were significant but mostly weak familial associations between multimorbidity in relatives and VTE. CONCLUSIONS Increasing multimorbidity exhibits a strong and increasing association with VTE. Familial associations suggest a weak shared familial susceptibility. The association between multimorbidity and VTE suggests that future cohort studies where multimorbidity is used to predict VTE might be worthwhile.
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Affiliation(s)
- Jonatan Ahrén
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - MirNabi Pirouzifard
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Anders Halling
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
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6
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Scheres LJJ, Hylckama Vlieg A, Cannegieter SC. Sex‐specific aspects of venous thromboembolism: What is new and what is next? Res Pract Thromb Haemost 2022; 6:e12722. [PMID: 35619638 PMCID: PMC9127145 DOI: 10.1002/rth2.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
Men seem to have a higher intrinsic risk of venous thromboembolism (VTE) than women, regardless of age. To date, this difference has not been explained. By integrating state‐of‐the‐art research presented at the International Society on Thrombosis and Haemostasis Congress of 2021 with the available literature, we address potential explanations for this intriguing risk difference between men and women. We discuss the role of exogenous and endogenous sex hormones as the most important known sex‐specific determinants of VTE risk. In addition, we highlight clues on the role of sex hormones and VTE risk from clinical scenarios such as pregnancy and the polycystic ovary syndrome. Furthermore, we address new potential sex‐specific risk factors and unanswered research questions, which could provide more insight in the intrinsic risk difference between men and women, such as body height and differences in body fat distribution, leading to dysregulation of metabolism and inflammation.
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Affiliation(s)
- Luuk J. J. Scheres
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS) Radboud University Medical Center Nijmegen The Netherlands
| | - Astrid Hylckama Vlieg
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
| | - Suzanne C. Cannegieter
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
- Department of Internal Medicine Section of Thrombosis and Haemostasis Leiden University Medical Center Leiden The Netherlands
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7
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Adamo A, Spiezia L, Dalla VF, Avruscio G, Simioni P. Potential Association between Distal Deep Vein Thrombosis and Asymptomatic Atherosclerosis. TH OPEN 2022; 5:e585-e590. [PMID: 34984318 PMCID: PMC8718265 DOI: 10.1055/s-0041-1741076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/11/2021] [Indexed: 01/10/2023] Open
Abstract
Background
Several studies have previously reported an association between idiopathic proximal deep vein thrombosis (DVT) and atherosclerosis, but whether spontaneous distal DVT is associated with asymptomatic atherosclerosis is still unknown.
Methods
Ultrasonography of the carotid arteries was done for plaque detection and intima-media thickness (IMT) evaluation, and the ankle-brachial index (ABI) in 116 patients with spontaneous DVT and without symptomatic atherosclerosis. Fifty-seven patients (M/F 19/38, age range 54–78 years) had distal DVT and 59 (M/F 24/35, age range 51–73 years) had proximal DVT. A group of 57 (M/F 21/36, age range 64–70 years) matched subjects acted as controls.
Results
No significant difference was found in carotid plaques between patients with distal or proximal DVT versus controls (
p
> 0.05 in all comparisons). Carotid IMT (mean ± SD) was significantly increased in patients with distal (1.00 ± 0.20 mm) and proximal (0.98 ± 0.16 mm) DVT versus controls (0.88 ± 0.15 mm,
p
<0.01 in both comparisons). An ABI £ 0.9 was found in 3/57 (5.3%) and 5/59 (8.5%) patients with distal and proximal DVT, respectively versus no controls with abnormal ABI.
Conclusion
Our results revealed that there may be an association between spontaneous distal DVT and asymptomatic atherosclerosis, and confirmed the known association between idiopathic proximal DVT and asymptomatic atherosclerosis. Larger studies are needed to confirm our results and to evaluate their clinical implications.
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Affiliation(s)
- Angelo Adamo
- Department of Medicine, Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy
| | - Luca Spiezia
- Department of Medicine, Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy
| | - Valle Fabio Dalla
- Department of Medicine, Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy
| | - Giampiero Avruscio
- Department of Cardiac, Angiology Unit, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Paolo Simioni
- Department of Medicine, Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy
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8
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Accelerated fibrin clot degradation is associated with arterial thromboembolism in patients following venous thrombosis: a cohort study. Sci Rep 2021; 11:21003. [PMID: 34702844 PMCID: PMC8548328 DOI: 10.1038/s41598-021-00411-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/24/2021] [Indexed: 11/08/2022] Open
Abstract
Several lines of evidence have suggested that patients following venous thromboembolism (VTE) are at higher risk of arterial thromboembolism (ATE). Prothrombotic fibrin clot characteristics were reported in individuals with cardiovascular risk factors. We investigated whether specific fibrin clot properties measured after 3-4 months of anticoagulation characterize VTE patients with subsequent ATE. We enrolled 320 patients following VTE aged below 70 years (median age, 46). Ten patients were lost to follow-up. ATE occurred in 21 individuals after a median 54 (31-68) months during a follow-up of 87.5 months (incidence 0.94%; 95% confidence interval [CI], 0.59-1.4 per patient-year). Patients with ATE had faster fibrin clot degradation, reflected by maximum rate of D-dimer increase during plasma clot lysis induced by tissue-type plasminogen activator (D-Drate) at baseline. Clot permeability, turbidimetric variables, clot lysis time, and thrombin generation were unrelated to ATE. Univariable Cox proportional hazards analysis showed that age, diabetes, and D-Drate were risk factors for subsequent ATE. Increased D-Drate (by 0.001 mg/L/min; hazard ratio, 1.08; 95% CI 1.02-1.14) was an independent predictor of ATE after adjustment for potential confounders. Faster fibrin clot degradation at 3 months since VTE may increase the risk of ATE among VTE patients during follow-up.
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9
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Abstract
PURPOSE OF REVIEW The present review discusses in-depth about neurological complications following acute venous thromboembolism (VTE). RECENT FINDINGS Intracranial hemorrhage, acute ischemic cerebrovascular events, and VTE in brain tumors are described as central nervous system (CNS) complications of PE, while peripheral neuropathy and neuropathic pain are reported as peripheral nervous system (PNS) sequelae of PE. Syncope and seizure are illustrated as atypical neurological presentations of PE. Mounting evidence suggests higher risk of venous thromboembolism (VTE) in patients with neurological diseases, but data on reverse, i.e., neurological sequelae following VTE, is underexplored. The present review is an attempt to explore some of the latter issues categorized into CNS, PNS, and atypical complications following VTE.
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10
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Lin CC, Chen CC, Li CI, Liu CS, Lin WY, Lin CH, Yang SY, Li TC. Derivation and validation of a clinical prediction model for risks of venous thromboembolism in diabetic and general populations. Medicine (Baltimore) 2021; 100:e27367. [PMID: 34596150 PMCID: PMC8483831 DOI: 10.1097/md.0000000000027367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Most studies on the prediction of venous thromboembolism (VTE) focused on hospitalized, surgery, and cancer patients or women receiving hormonal contraceptives or menopausal hormone therapy. No study considered diabetic and general populations to establish a VTE prediction model, especially in Asia. We developed a predictive model for VTE among type 2 diabetic patients and the general population.This study considered 2 nationwide retrospective cohort studies consisting of 52,427 diabetic participants and 508,664 participants from the general population aged 30 to 85 years during 2001 to 2004 in Taiwan. All participants were followed up until VTE event, death, or December 2011. The outcome event was VTE, including deep venous thrombosis and pulmonary embolism. Candidate predictors consisted of socio-demographic factors, diabetes-related factors and biomarkers, comorbidities, and medicine use. Our study followed the procedures proposed by the Framingham Heart Study to develop prediction models by using a Cox regression model. The predictive accuracy and performance characteristics were assessed using the area under curve of receiver operating characteristics curve and calibration of a risk score were performed by Hosmer-Lemeshow goodness-of-fit test.The common factors for persons with type 2 diabetes and general population included age, hospitalization status 1 year before the baseline, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and anti-diabetes medications; the specific factors for persons with type 2 diabetes consisted of body mass index, glycosylated hemoglobin A1C, and creatinine; and the factors for general population included gender, peripheral vascular disease, cancer, hypertension medication, cardiovascular medication, and non-steroidal anti-inflammatory drug. The area under curve of 3-, 5-, and 8-year VTE prediction models were 0.74, 0.71, and 0.69 in the diabetic population and 0.77, 0.76, and 0.75 in the general population, respectively.The new clinical prediction models can help identify a high risk of VTE and provide medical intervention in diabetic and general populations.
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Affiliation(s)
- Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Chu Chen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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11
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Soudet S, Jedraszak G, Evrard O, Marolleau JP, Garcon L, Pietri MAS. Is Hematopoietic Clonality of Indetermined Potential a Risk Factor for Pulmonary Embolism? TH OPEN 2021; 5:e338-e342. [PMID: 34414354 PMCID: PMC8370792 DOI: 10.1055/s-0041-1733856] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background
Unprovoked pulmonary embolism (uPE) is a severe and frequent condition. Identification of new risk factors is mandatory to identify patients that would benefit from a long-term treatment. Clonal hematopoiesis of indeterminate potential (CHIP) is defined by the acquisition of somatic mutations that drive clonal expansion in the absence of cytopenia. Its prevalence is estimated of 5% in the population above 65 years. Since inflammation and endothelial dysfunction may share a pathophysiological pathway(1), we hypothesized that CHIP, may be a risk factor for uPE.
Methods
We conducted a pilot retrospective observational study. Patients with iPE between 18 to 65 years old were included. PE was considered as unprovoked, when no transient nor persistant risk factor was present and when thrombophilia testing was negative. We excluded documented atherosclerosis, personal or familial history of VTE and presence of cytopenias. CHIP proportion in uPE patients were analyzed using next generation sequencing of the coding sequence of a custom panel composed by
DNMT3A, ASXL1, SF3B1, TET2
and
TP 53
.
Results
Upon 61 patients with uPE consecutively included, a total of 19 somatic mutations were found in 12 patients (20%) IC95% [10 - 20]. 15 mutations were found in
DNMT3A
gene, 3 in
ASXL1
and one in
TET2
. There was no diference in terms of age, PE location, DVT presence and risk stratification in CHIP carriers and non carriers.
Conclusion
We report for the first time, the presence of high rates of CHIP in patients presenting with uPE. Thus, CHIP may be a new risk factor for VTE. These results need to be confirmed in an ongoing prospective case-control study including more patients and using a more diverse gene panel to better determine CHIP incidence in uPE.
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Affiliation(s)
- S Soudet
- Department of Vascular Medicine, CHU Amiens Picardie, Amiens, France.,EA 7516 CHIMERE, Université Picardie Jules Verne, Amiens, France
| | - G Jedraszak
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - O Evrard
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - J P Marolleau
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - L Garcon
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - M A Sevestre Pietri
- Department of Vascular Medicine, CHU Amiens Picardie, Amiens, France.,EA 7516 CHIMERE, Université Picardie Jules Verne, Amiens, France
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12
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The effect of deep vein thrombosis on major adverse limb events in diabetic patients: a nationwide retrospective cohort study. Sci Rep 2021; 11:8082. [PMID: 33850207 PMCID: PMC8044219 DOI: 10.1038/s41598-021-87461-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Little is known about the association between deep vein thrombosis (DVT) and arterial complications in patients with type 2 diabetes (T2DM). The aim of this retrospective cohort study was to assess the influence of prior DVT on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in T2DM. A total of 1,628,675 patients with T2DM with or without a history of DVT from 2001 to 2013 were identified in the National Health Insurance Research Database of Taiwan. Before matching, the patients in the DVT group (n = 2020) were older than the control group (66.3 vs. 58.3 years). Patients in the DVT group were more likely to be female than the control group (54.3% vs. 47.5%). Before matching, the DVT group had higher prevalence of most comorbidities, more prescription of antiplatelet, antihypertensive agents and insulins, but less prescription of metformin and sulfonylurea. During a mean follow-up of 5.2 years (standard deviation: 3.9 years), the matched DVT group (n = 2017) have a significantly increased risk of MALE (8.4% vs. 5.2%; subdistribution hazard ratio [SHR] 1.60, 95% CI 1.34–1.90), foot ulcer (5.2% vs. 2.6%, SHR 1.96, 95% CI 1.57–2.45), gangrene (3.4% vs. 2.3%, SHR 1.44, 95% CI 1.10–1.90) and amputation (2.5% vs. 1.7%; SHR 1.42, 95% CI 1.03–1.95) than the 10,085 matched controls without DVT. They also tended to have a greater risk of all-cause mortality (38.1% vs. 33.1%; hazard ratio [HR] 1.18, 95% CI 1.09–1.27) and systemic thromboembolism (4.2% vs. 2.6%; SHR 1.56, 95% CI 1.22–1.99), respectively. We showed the presence of DVT may be associated with an increased risk of MALEs, major amputation, and thromboembolism, contributing to a higher mortality rate in T2DM.
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Hounkpe BW, Benatti RDO, Carvalho BDS, De Paula EV. Identification of common and divergent gene expression signatures in patients with venous and arterial thrombosis using data from public repositories. PLoS One 2020; 15:e0235501. [PMID: 32780732 PMCID: PMC7418995 DOI: 10.1371/journal.pone.0235501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
STRENGTHS AND LIMITATIONS OF THIS STUDY Our results represent the first comparison of venous and arterial thrombosis at the transcriptomic level.Our main result was the demonstration that immunothrombosis pathways are important to the pathophysiology of these conditions, also at the transcriptomic level.A specific signature for venous and arterial thrombosis was described, and validated in independent cohorts.The limited number of public repositories with gene expression data from patients with venous thromboembolism limits the representation of these patients in our analyses.In order to gather a meaningful number of studies with gene expression data we had to include patients in different time-points since the index thrombotic event, which might have increased the heterogeneity of our population.
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Affiliation(s)
| | | | - Benilton de Sá Carvalho
- Department of Statistics, Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, SP, Brazil
| | - Erich Vinicius De Paula
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
- Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil
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Prandoni P. Is there a link between venous and arterial thrombosis? A reappraisal. Intern Emerg Med 2020; 15:33-36. [PMID: 31773560 DOI: 10.1007/s11739-019-02238-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Whether there is a link between venous and arterial thrombotic disorders is still a matter of debate. They share common risk factors, such as old age, male sex and obesity. Endothelial dysfunction and inflammation are likely to play a role in determining the simultaneous involvement of the two vascular compartments. Unlike subclinical atherosclerosis, symptomatic complications of atherosclerosis such as myocardial infarction, ischemic stroke and atrial fibrillation are likely to predict the subsequent development of venous thromboembolic (VTE) complications. Patients with VTE, especially those with apparently unprovoked episodes, have a definitely increased risk of subsequent arterial thrombotic disorders. Drugs that reduce the risk of arterial thrombosis are likely to reduce the risk of venous thrombosis and vice versa. In particular, the direct oral anticoagulants have recently been shown to reduce the risk of both vascular disorders. In conclusion, recent evidence provides compelling evidence in support of the link between venous and arterial thrombosis. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.
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Affiliation(s)
- Paolo Prandoni
- Arianna Foundation On Anticoagulation, Via P. Fabbri 1/3, 40138, Bologna, Italy.
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15
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Sznajder M, Dzikowska-Diduch O, Kurnicka K, Roik M, Wretowski D, Pruszczyk P, Kostrubiec M. Increased systemic arterial stiffness in patients with chronic thromboembolic pulmonary hypertension. Cardiol J 2018; 27:742-748. [PMID: 30234892 DOI: 10.5603/cj.a2018.0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 09/13/2018] [Accepted: 03/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thromboembolism (VTE) resulting from non-dissolving thromboemboli in the pulmonary arteries. Previous observations indicate a higher prevalence of atherosclerosis and cardiovascular risk factors in patients with VTE and CTEPH. The purpose of the present study was to evaluate the arterial stiffening assessed by pulse wave velocity (PWV), a marker of arterial stiffness, in CTEPH patients in comparison with a matched control group (CG). METHODS The study group consisted of 26 CTEPH patients (9 male and 17 female, age 69 ± 10 years) and 22 CG (10 male, 12 female, age 67 ± 8 years). In all subjects a physical examination, carotid-femoral PWV and transthoracic echocardiography were performed. Right heart catheterization was done in all CTEPH. RESULTS Chronic tromboembolic pulmonary hypertension patients had significantly higher PWV than CG (10.3 ± 2.5 m/s vs. 9 ± 1.3 m/s, p < 0.05), even though systolic blood pressure was higher in CG (120 ± 11 vs. 132 ± 14 mmHg, p = 0.002). PWV correlated only with age and pulmonary vascular resistance (PVR) in CTEPH (r = 0.45, p = 0.03 and r = 0.43, p = 0.03, respectively). Arterial stiffening defined as PWV > 10 m/s was found in 11 (42%) CTEPH patients and in 5 (23%) cases from CG (p = 0.13). CTEPH patients with PWV > 10 m/s were older (74 ± 8 vs. 66 ± 10 years, p < 0.05), had decreased oxygen saturation (SaO2 89 [73-96]% vs. 96 [85-98]%, p < 0.01) and tended to have higher PVR (8.1 [3.1-14.0] vs. 5.2 [3.1-12.7] HRU, p = 0.10). CONCLUSIONS Arterial stiffness, assessed with PWV, is increased in CTEPH. The elevated PWV is associated with older age, lower SaO2 and higher PVR in CTEPH.
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Affiliation(s)
- Monika Sznajder
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Dominik Wretowski
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology with Venous Thromboembolism Center, Medical University of Warsaw, 4 Lindleya St, 02-005 Warsaw, Poland.
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Mi Y, Yan S, Lu Y, Liang Y, Li C. Venous thromboembolism has the same risk factors as atherosclerosis: A PRISMA-compliant systemic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4495. [PMID: 27512866 PMCID: PMC4985321 DOI: 10.1097/md.0000000000004495] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Previous studies have shown that idiopathic pulmonary embolism is positively associated with other cardiovascular events, such as myocardial infarction and stroke, suggesting a potentially important association between atherosclerosis risk factors and venous thromboembolism (VTE). We performed a meta-analysis to evaluate the correlation between risk factors for atherosclerosis and VTE. METHODS In December 2014, we searched MEDLINE and EMBASE for studies evaluating the associations between VTE and risk factors for atherosclerosis and pooled outcome data using random-effects meta-analysis. In addition, we analyzed publication bias. RESULTS Thirty-three case-control and cohort studies with a total of 185,124 patients met the inclusion criteria. We found that participants with body mass index (BMI) ≥30 kg/m had a significantly higher prevalence of VTE than those with BMI <30 kg/m in both case-control studies (odds ratio [OR] = 2.45, 95% confidence interval [CI]: 1.78-3.35) and cohort studies (relative risk [RR] = 2.39, 95% CI: 1.79-3.17). VTE was more prevalent in patients with hypertension than without hypertension (OR = 1.40, 95% CI: 1.06-1.84; RR = 1.36, 95% CI: 1.11-1.67). The findings were similar for VTE prevalence between patients with and without diabetes (OR = 1.78, 95% CI: 1.17-2.69; RR = 1.41, 95% CI: 1.20-1.66). Current smoking was significantly associated with VTE prevalence in case-control studies (OR = 1.34, 95% CI: 1.01-1.77), but not in cohort studies (RR = 1.29, 95% CI: 0.96-1.72). In addition, we found that total cholesterol and triglyceride concentrations were significantly higher in patients with VTE than without VTE (weighted mean differences [WMD] = 8.94 mg/dL, 95% CI: 3.52-14.35 mg/dL, and WMD = 14.00 mg/dL, 95% CI: 8.85-19.16 mg/dL, respectively). High-density lipoprotein cholesterol concentrations were significantly lower in patients with VTE than without VTE (WMD = -2.03 mg/dL, 95% CI: -3.42 to -0.63 mg/dL). Higher quality studies were more homogeneous, but confirmed the same significant associations. CONCLUSIONS Based on our systematic review and meta-analysis, we observed a significant association between VTE and the risk factors for atherosclerosis. These results may make an important contribution to clinical practice regarding VTE treatment.
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Affiliation(s)
- Yuhong Mi
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Disease, Beijing, China
| | - Shufeng Yan
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Disease, Beijing, China
| | - Yanhui Lu
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Disease, Beijing, China
| | - Ying Liang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Disease, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Shantsila A, Lip GYH. Can venous thromboembolism navigate the prevention of cardiovascular complications? ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207244 DOI: 10.3978/j.issn.2305-5839.2015.04.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Alena Shantsila
- 1 University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK ; 2 Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- 1 University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK ; 2 Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
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Adelborg K, Sundbøll J, Sørensen HT. Arterial cardiovascular events and mortality following venous thromboembolism. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207245 DOI: 10.3978/j.issn.2305-5839.2015.04.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Wells PS, Gebel M, Prins MH, Davidson BL, Lensing AW. Influence of statin use on the incidence of recurrent venous thromboembolism and major bleeding in patients receiving rivaroxaban or standard anticoagulant therapy. Thromb J 2014; 12:26. [PMID: 25698905 PMCID: PMC4334416 DOI: 10.1186/1477-9560-12-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022] Open
Abstract
Background Statins may reduce the risk of first and recurrent venous thromboembolism (VTE). No data are available on their potential benefit in patients treated with the oral anticoagulant rivaroxaban. Methods The EINSTEIN DVT/PE and EINSTEIN Extension studies compared rivaroxaban with standard of care (n=8280) and placebo (n=1188), respectively. The incidences of recurrent VTE and major bleeding per 100 patient-years for exposure (or not) to statins were calculated. A Cox proportional hazards model was constructed, stratified by index event and intended treatment duration, with statin use as a time-dependent variable, for each treatment group (rivaroxaban vs enoxaparin/vitamin K antagonist or placebo) and adjusted for relevant variables. Results In EINSTEIN DVT/PE, 1509 (18.3%) patients used statins during the at-risk period, and 6731 (81.7%) did not. Overall, 2.6 recurrent VTEs occurred per 100 patient-years with statin use compared with 3.8 per 100 patient-years without statins (adjusted hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.46–1.25). HRs for recurrent VTE were similar for concomitant use of rivaroxaban-statin and enoxaparin/VKA-statin. Major bleeding events occurred in 3.0 per 100 patient-years with statin use compared with 2.3 per 100 patient-years without statins (adjusted HR 0.77; 95% CI 0.46–1.29). Due to adjustments in the Cox regression model, the direction of this HR is in contrast to the crude comparison. In EINSTEIN Extension, no recurrent VTEs occurred with statin use in the rivaroxaban group compared with 1.6 per 100 patient-years without statins. In the placebo group, 12.2 recurrent VTEs occurred per 100 patient-years with statin use compared with 13.2 per 100 patient-years without (adjusted HR 0.81; 95% CI 0.35–1.86). Conclusions The effect of statins in this secondary analysis of the EINSTEIN VTE treatment program is consistent with other studies that suggest a reduced risk of recurrent VTE, but conclusive evidence of this benefit is lacking. Statins are simple to use, inexpensive, very safe and do not cause bleeding. Therefore, the potential effect on reducing recurrent VTE, which is in the range of that of acetylsalicylic acid, deserves evaluation in a large randomized trial. Trial registration number ClinicalTrials.gov: EINSTEIN PE, NCT00439777; EINSTEIN DVT, NCT00440193; EINSTEIN Extension, NCT00439725.
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Affiliation(s)
- Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Martin H Prins
- Maastricht University Medical Center, Maastricht, The Netherlands
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Ageno W, Di Minno MND, Ay C, Jang MJ, Hansen JB, Steffen LM, Vayà A, Rattazzi M, Pabinger I, Oh D, Di Minno G, Braekkan SK, Cushman M, Bonet E, Pauletto P, Squizzato A, Dentali F. Association between the metabolic syndrome, its individual components, and unprovoked venous thromboembolism: results of a patient-level meta-analysis. Arterioscler Thromb Vasc Biol 2014; 34:2478-85. [PMID: 25212233 PMCID: PMC4322778 DOI: 10.1161/atvbaha.114.304085] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The metabolic syndrome (MetS) may contribute to the pathogenesis of venous thromboembolism (VTE), but this association requires additional investigation. APPROACH AND RESULTS We performed a patient-level meta-analysis of case-control and cohort studies that evaluated the role of MetS and risk of unprovoked VTE. For case-control studies, odds ratios and 95% confidence intervals were calculated using logistic regression analysis to estimate the influence of individual variables on the risk of VTE; χ(2) tests for trend were used to investigate the effect of increasing number of components of MetS on the risk of VTE and to explore the influence of abdominal obesity on this relationship. For cohort studies, hazard ratios and 95% confidence interval were calculated using multivariable Cox regression analysis. Six case-control studies were included (908 cases with unprovoked VTE and 1794 controls): in multivariate analysis, MetS was independently associated with VTE (odds ratio, 1.91; 95% confidence interval, 1.57-2.33), and both MetS and abdominal obesity were better predictors of unprovoked VTE than obesity defined by the body mass index. Two prospective cohort studies were included (26,531 subjects and 289 unprovoked VTE events): age, obesity, and abdominal obesity, but not MetS were associated with VTE. CONCLUSIONS Case-control but not prospective cohort studies support an association between MetS and VTE. Abdominal adiposity is a strong risk factor for VTE.
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Affiliation(s)
- Walter Ageno
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.).
| | - Matteo N D Di Minno
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Cihan Ay
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Moon Ju Jang
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - John-Bjarne Hansen
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Lyn M Steffen
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Amparo Vayà
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Marcello Rattazzi
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Ingrid Pabinger
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Doyeun Oh
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Giovanni Di Minno
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Sigrid K Braekkan
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Mary Cushman
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Elena Bonet
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Paolo Pauletto
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Alessandro Squizzato
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
| | - Francesco Dentali
- From the Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy (W.A., A.S., F.D.); Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.N.D.D.M.); Department of Experimental and Clinical Medicine, Federico II University, Napoli, Italy (M.N.D.D.M., G.D.M.); Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria (C.A., I.P.); Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea (M.J.J., D.O.); Department of Clinical Medicine, University of Tromso, Tromso, Norway (J.-B.H., S.K.B.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S.); Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.); Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain (A.V., E.B.); and Department of Internal Medicine, Ca' Foncello Hospital, Treviso, Italy (M.R., P.P.)
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Barsoum MK, Cohoon KP, Roger VL, Mehta RA, Hodge DO, Bailey KR, Heit JA. Are myocardial infarction and venous thromboembolism associated? Population-based case-control and cohort studies. Thromb Res 2014; 134:593-8. [PMID: 25037496 PMCID: PMC4142114 DOI: 10.1016/j.thromres.2014.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/17/2014] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Because the association of myocardial infarction (MI) and venous thromboembolism (VTE) is uncertain, we tested MI as a VTE risk factor and VTE as a predictor of MI. MATERIALS AND METHODS Using Rochester Epidemiology Project resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE over the 13-year period, 1988-2000 (n=1311), one to two resident controls per VTE case (n=1511), and all residents with incident MI over the 31-year period, 1979-2010. For VTE cases and controls, we reviewed their complete medical records in the community for VTE and MI risk factors. Using conditional logistic regression we tested MI as a potential VTE risk factor, both unadjusted and after adjusting for VTE risk factors. We also followed VTE cases and controls without prior MI forward in time for incident MI through 12/31/2010, and using Cox proportional hazards modeling, tested VTE as a predictor of MI, both unadjusted and after adjusting for MI risk factors. RESULTS The number (%) of MI prior to VTE among cases and controls were 75 (5.7) and 51 (3.4), respectively, and the number (%) of MI after VTE among cases and controls were 58 (4.4) and 77 (5.1), respectively. In univariate analyses, MI was significantly associated with VTE but not after adjusting for VTE risk factors. In both univariate and multivariate analyses, VTE (overall or idiopathic) was not a predictor of MI. CONCLUSIONS MI is not an independent risk factor for VTE, and VTE is not a predictor of MI.
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Affiliation(s)
- Michel K Barsoum
- Divisions of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin P Cohoon
- Divisions of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Véronique L Roger
- Divisions of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John A Heit
- Divisions of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
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22
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Trottier-Tellier F, Durand M, Kolan C, Wistaff R, Nguyen PV, Laskine M. Recurrent arterial and venous thromboemboli as initial presentation of acute promyelocytic leukemia. J Clin Med Res 2014; 6:388-91. [PMID: 25110545 PMCID: PMC4125336 DOI: 10.14740/jocmr1864w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 11/21/2022] Open
Abstract
We report a case of a 52-year-old Caucasian woman diagnosed with a synchronic arterial and venous thrombosis as an initial presentation of an acute promyelocytic leukemia (APL). After the diagnosis, the patient was treated with all trans-retinoic acid and arsenic chemotherapy concomitant to systemic anticoagulation. This treatment regimen led to a complete remission and absence of relapse of the thrombosis or APL during the follow-up. To our knowledge, this presentation is the second case in the literature. We use this opportunity to emphasize the importance of performing a complete medical evaluation in cases of unusual thromboembolic events.
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Affiliation(s)
| | - Madeleine Durand
- Department of Medicine, Hopital Hotel-Dieu, CRCHUM, Montreal, Canada
| | - Christophe Kolan
- Department of Medicine, Hopital Hotel-Dieu, CHUM, Montreal, Canada
| | - Robert Wistaff
- Department of Medicine, Hopital Hotel-Dieu, CHUM, Montreal, Canada
| | - Paul Van Nguyen
- Department of Medicine, Hopital Hotel-Dieu, CHUM, Montreal, Canada
| | - Mikhael Laskine
- Department of Medicine, Hopital Hotel-Dieu, CRCHUM, Montreal, Canada
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23
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Wolberg AS, Aleman MM, Leiderman K, Machlus KR. Procoagulant activity in hemostasis and thrombosis: Virchow's triad revisited. Anesth Analg 2011; 114:275-85. [PMID: 22104070 DOI: 10.1213/ane.0b013e31823a088c] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Virchow's triad is traditionally invoked to explain pathophysiologic mechanisms leading to thrombosis, alleging concerted roles for abnormalities in blood composition, vessel wall components, and blood flow in the development of arterial and venous thrombosis. Given the tissue-specific bleeding observed in hemophilia patients, it may be instructive to consider the principles of Virchow's triad when investigating mechanisms operant in hemostatic disorders as well. Blood composition (the function of circulating blood cells and plasma proteins) is the most well studied component of the triad. For example, increased levels of plasma procoagulant proteins such as prothrombin and fibrinogen are established risk factors for thrombosis, whereas deficiencies in plasma factors VIII and IX result in bleeding (hemophilia A and B, respectively). Vessel wall (cellular) components contribute adhesion molecules that recruit circulating leukocytes and platelets to sites of vascular damage, tissue factor, which provides a procoagulant signal of vascular breach, and a surface upon which coagulation complexes are assembled. Blood flow is often characterized by 2 key variables: shear rate and shear stress. Shear rate affects several aspects of coagulation, including transport rates of platelets and plasma proteins to and from the injury site, platelet activation, and the kinetics of fibrin monomer formation and polymerization. Shear stress modulates adhesion rates of platelets and expression of adhesion molecules and procoagulant activity on endothelial cells lining the blood vessels. That no one abnormality in any component of Virchow's triad fully predicts coagulopathy a priori suggests coagulopathies are complex, multifactorial, and interactive. In this review, we focus on contributions of blood composition, vascular cells, and blood flow to hemostasis and thrombosis, and suggest that cross-talk among the 3 components of Virchow's triad is necessary for hemostasis and determines propensity for thrombosis or bleeding. Investigative models that permit interplay among these components are necessary to understand the operant pathophysiology, and effectively treat and prevent thrombotic and bleeding disorders.
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Affiliation(s)
- Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599-7525, USA.
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Blann AD, Dunmore S. Arterial and venous thrombosis in cancer patients. Cardiol Res Pract 2011; 2011:394740. [PMID: 21403876 PMCID: PMC3051163 DOI: 10.4061/2011/394740] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 01/04/2011] [Indexed: 12/26/2022] Open
Abstract
The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.
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Affiliation(s)
- Andrew D Blann
- University of Birmingham Centre for Cardiovascular Sciences, Department of Medicine, City Hospital, Birmingham B18 7QH, UK
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