Increased Risk of Deep Vein Thrombosis and Pulmonary Thromboembolism in Patients With Organophosphate Intoxication

Abstract

Organophosphate (OP) poisoning is a critical cause of morbidity and mortality worldwide. We conducted a nationwide longitudinal cohort study to investigate the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) among patients admitted with OP intoxication.We identified patients with OP intoxication by using the Taiwan National Health Insurance Research Database and enrolled 9223 patients who were hospitalized for OP intoxication between 2000 and 2011. OP intoxication was diagnosed based on a clinical assessment and serum acetylcholinesterase levels at the time of hospital admission. Each patient in the OP intoxication cohort was randomly frequency matched with 4 patients without OP intoxication based on their age, sex, and index year (36,892 patients as control cohort), and all patients were observed from the index date until the appearance of a DVT or a PTE event, or until December 31, 2011. We analyzed the risks of DVT and PTE by using Cox proportional hazards regression models that included the demographic variables of sex, age, and comorbidities (eg, hypertension, diabetes, cerebral vascular disease, heart failure, all cancer types, and lower leg fracture or surgery).The results revealed a significantly increased risk of developing DVT among patients with OP poisoning (adjusted hazard ratio [HR] = 1.55; 95% confidence interval [CI] = 1.03–2.34) but not PTE (adjusted HR = 1.44; 95% CI = 0.83–2.52). Among the patients without comorbidities, the OP poisoning patients compared with controls had a higher adjusted HR of 2.12 (95% CI = 1.21–3.71) for DVT.The results of this nationwide cohort study indicate that the risk of developing DVT is markedly higher in patients with OP intoxication compared with that of the general population.

Incidence of Venous Thromboembolism in Asian Populations: A Systematic Review

“…The disorders included systemic lupus erythematosus (SLE; PE rate of 10.2 per 10,000 patientyears; HR: 19.7; 95% confidence interval [CI]: 11.9; 32.8), 11 systemic sclerosis (SSc) (10.8 per 10,000 patient-years), 12 chronic obstructive pulmonary disease (COPD; 12.31 per 10,000 patient-years) 13 and asthma (10.2 per 10,000 patientyears). 14 Estimated incidence rates of DVTwere also significantly higher in patients with COPD, 13,15 SLE, 11 Sjogren's syndrome (SS), 16 SSc, 12 rheumatoid arthritis, 17,18 inflammatory bowel disease (IBD), pneumococcal pneumonia, 19 Other conditions with higher estimated incidence rates of DVT or VTE, compared with controls, included spinal cord injury, 24 organophosphate toxicity, 25 carbon monoxide poisoning, 26 schizophrenia, 27 sleep disorders, 28 hormone replacement therapy 29 and type 2 diabetes mellitus. 30 Metformin use in type 2 diabetes was associated with a reduced risk of DVT with 0.22% of cases compared with 0.56% of controls affected (HR: 0.43; 95% CI: 0.24, 0.56; 31 ►Table 3).…”

Acute Anticholinesterase Pesticide Poisoning Caused a Long-Term Mortality Increase

“…Organophosphates and carbamates are the most commonly used agricultural and household anticholinesterase pesticides. 1 , 2 They inhibit cholinesterase activity, which overstimulates nicotinic and muscarinic acetylcholine receptors. 3 – 7 The serious signs and symptoms of acute anticholinesterase pesticide poisoning (ACPP) are agitation, confusion, coma, respiratory failure, and sometimes death.…”

“… 7 Despite an awareness of the toxicity, the incidence of accidental, environmental, and occupational exposures and suicidal poisoning remain high, especially in developing countries, because anticholinesterase pesticides are effective and convenient. 1 , 2 , 7 …”

“…Under high oxidative stress, cells typically undergo necrosis because of tissue damage, which can include subchronic and chronic toxicity and inflammation in various tissue types throughout the body. 15 , 16 Some studies 1 , 7 have been conducted but focus almost exclusively on predicting acute mortality and managing complications; however, the long-term prognosis of ACPP is still unclear. Therefore, we used Taiwan's National Health Insurance Research Database (NHIRD) to investigate, in a nationwide retrospective cohort study, the long-term mortality of patients with ACPP.…”

Terbufos-sulfone exacerbates cardiac lesions in diabetic rats: a sub-acute toxicity study

“…A significant association between OPC exposure and toxic effects on different organs has been reported in numerous epidemiological studies (1)(2)(3). Among several toxic manifestations, cardiotoxicity is believed to be one of the unrecognised risk factors of OPCs.…”