Atrial fibrillation and future risk of venous thromboembolism:the Tromsø study

Enga, Kristin F.; Rye-Holmboe, I.; Hald, Erin Mathiesen; Løchen, Maja‐Lisa; Mathiesen, Ellisiv B.; Njølstad, Inger; Wilsgaard, Tom; Brækkan, Sigrid Kufaas; Hansen, John‐Bjarne

doi:10.1111/jth.12762

Cited by 85 publications

(85 citation statements)

References 27 publications

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“…241 A Norwegian administrative database study reported that AF was associated with an increased risk of pulmonary embolism (adjusted HR, 1.83; 95% CI, 1.16–2.90) but not VTE (adjusted HR, 1.04; 95% CI, 0.64–1.68). 239 In addition, the same study found that individuals with incident VTE were subsequently at a higher risk of developing incident AF (adjusted HR, 1.63; 95% CI, 1.22–2.17) compared to those without VTE. 240 It should be noted that in both the Taiwanese and Norwegian cohorts, a significant proportion of individuals had pre-exiting RFs for VTE including lower extremity fracture, recent surgery, cancer, and immobility.…”

Section: Clinical Outcomesmentioning

confidence: 93%

“…Potential direct causal relationship between AF and VTE has been proposed, but needs to be studied further. 239, 240 …”

Section: Clinical Outcomesmentioning

confidence: 99%

“…240 It should be noted that in both the Taiwanese and Norwegian cohorts, a significant proportion of individuals had pre-exiting RFs for VTE including lower extremity fracture, recent surgery, cancer, and immobility. 239, 241 In comparison to individuals with AF or VTE alone, those with AF and VTE were older and had higher mean BMI. In the Norwegian study, the mean age and BMI were 64 years and 26.9 kg/m 2 for AF alone, 57 years and 26.7 kg/m 2 for VTE alone, and 68 years and 29.2 kg/m 2 for AF and VTE combined.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Atrial Fibrillation

Stærk

Sherer

et al. 2017

Circulation Research

897

380

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The last three decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported seventeen independent signals for AF at fourteen genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors, including sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF and each factor has been shown to induce structural and electrical remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.

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Section: Clinical Outcomesmentioning

confidence: 93%

“…Potential direct causal relationship between AF and VTE has been proposed, but needs to be studied further. 239, 240 …”

Section: Clinical Outcomesmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

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Atrial Fibrillation

Stærk

Sherer

et al. 2017

Circulation Research

897

380

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“…PEs can also originate from thrombi at the right side of the heart. Atrial fibrillation, pre‐disposing for intra‐cardiac thrombus formation, has been shown to be associated with VTE and PE in particular 14. Respiratory tract infection (RTI), including pneumonia, is associated with increased risk of VTE, and results from a case‐control study (the MEGA study) suggest that pneumonia has a stronger association with PE than DVT 6, 15.…”

Section: Introductionmentioning

confidence: 99%

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Grimnes

Isaksen

Tichelaar

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials There is a bidirectional relation between acute infections and immobilizationWe studied the impact of infection and immobilization on risk of VTE in a case‐crossover designAcute infection was a strong trigger for VTE independent of concomitant immobilizationInfection and immobilization had a synergistic effect on the VTE‐risk BackgroundA bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE‐risk is explained by immobilization is unknown.AimsTo investigate the impact of hospitalization with acute infection on the VTE‐risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory‐ (RTI) and urinary‐ (UTI) tract infections on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe conducted a case‐crossover study of VTE‐patients (n = 707) recruited from a general population. Hospitalizations and VTE‐triggers were registered during the 90 days before a VTE (hazard period) and in four preceding 90‐day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) for VTE according to triggers.ResultsAcute infection was registered in 267 (37.8%) of the hazard periods and in 107 (3.8%) of the control periods, corresponding to a high VTE‐risk after infection (OR 24.2, 95% CI 17.2‐34.0), that was attenuated to 15‐fold increased after adjustment for immobilization. The risk was 20‐fold increased after infection without concomitant immobilization, 73‐fold increased after immobilization without infection, and 141‐fold increased with the two combined. The risk of PE was apparently higher after RTIs (OR 48.3, 95% CI 19.4‐120.0) than UTIs (OR 12.6, 95% CI 6.4‐24.7), but diminished in sensitivity analyses excluding uncertain RTI diagnoses.ConclusionsOur findings suggest that hospitalization with infection is a strong VTE‐trigger also in non‐immobilized patients. Infection and immobilization had a synergistic effect on the VTE‐risk.

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“…1 The prevalence in high-income countries is 1–4%, but rises to more than 13% in individuals over 80 years of age. 2 Although embolic stroke is the most feared complication, over the past few decades AF has been associated with increased risk of myocardial infarction, 3 heart failure, 4 dementia, 5 chronic kidney disease, 6,7 venous thromboembolism, 8 and mortality. 9 Conversely, biologically plausible bidirectional relations have been reported, such that myocardial infarction, 10 heart failure, 10 chronic kidney disease, 6,7 and venous thromboembolism 11 are associated with increased risk of incident AF.…”

mentioning

confidence: 99%