Iron Deficiency Anemia as a Rare Risk Factor for Recurrent Pulmonary Embolism and Deep Vein Thrombosis

Ezeh, Ebubechukwu; Katabi, Abdulrahman; Khawaja, Imran S.

doi:10.7759/cureus.13721

Cited by 10 publications

(12 citation statements)

References 7 publications

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“…Additionally, consistent with previous reports, we found that cancer, 24 prior VTE, 24 immobilization, 24 an indwelling PICC line or infusion port, 32 surgery or trauma, 24 thrombocytosis, 31 anemia, 29,30 thrombophilia, 24 Black race, 37 recent major hemorrhage, 36 obesity, 24 male sex, 38 and acute infection were associated with HA-VTE risk. 24 In addition, we found in this study that the automatically captured illness severity indices COPS and LAPS 35 were associated with HA-VTE.…”

Section: Discussionsupporting

confidence: 92%

“…We defined 23 potential risk factors associated with HA-VTE based on prior studies, which were adapted to be used with retrospective EHR data. These included the 11 elements of the Padua Predictive Score, 24 as well as 12 additional previously identified risk factors 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 : active cancer, previous VTE, bed rest or immobilization, thrombophilia, recent trauma or surgery, age 70 years or older, current admission for heart or respiratory failure, current admission for ischemic stroke, acute infection, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or more, ongoing hormonal treatment, being an active tobacco smoker, poorly controlled diabetes (ie, hemoglobin A 1c ≥10.0% [to convert to proportion of total hemoglobin, multiply by 0.01]), low hemoglobin level (ie, <10.0 g/dL [to convert to grams per liter, multiply by 10.0]), high platelet count (ie, ≥500 ×10 3 /uL [to convert to ×10 9 per liter, multiply by 1.0]), presence of an infusion port or a peripherally inserted central (PICC) line, recent use of a serotonergic antidepressant, microalbuminuria, high illness severity index scores 39 (Comorbidity Point Score [COPS] ≥50 and Laboratory Acute Physiology Score [LAPS] ≥100) at time of admission, recent major hemorrhage (within 30 days prior to admission), race and ethnicity, requirement for language interpreter, and male sex. In addition, a covariate of pharmacological VTE prophylaxis in the first 48 hours after admission was defined based on completed medication orders (eAppendix in the Supplement ).…”

Section: Methodsmentioning

confidence: 99%

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Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

et al. 2022

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ImportanceWhile hospital-associated venous thromboembolism (HA-VTE) is a known complication of hospitalization, contemporary incidence and outcomes data are scarce and methodologically contested.ObjectiveTo define and validate an automated electronic health record (EHR)–based algorithm for retrospective detection of HA-VTE and examine contemporary HA-VTE incidence, previously reported risk factors, and outcomes.Design, Setting, and ParticipantsThis cohort study was conducted using hospital admissions between January 1, 2013, and June 30, 2021, with follow-up until December 31, 2021. All medical (non–intensive care unit) admissions at an integrated health care delivery system with 21 hospitals in Northern California during the study period were included. Data were analyzed from January to June 2022.ExposuresPreviously reported risk factors associated with HA-VTE and administration of pharmacological prophylaxis were evaluated as factors associated with HA-VTE.Main Outcomes and MeasuresYearly incidence rates and timing of HA-VTE events overall and by subtype (deep vein thrombosis, pulmonary embolism, both, or unknown), as well as readmissions and mortality rates.ResultsAmong 1 112 014 hospitalizations involving 529 492 patients (268 797 [50.8%] women; 75 238 Asian [14.2%], 52 697 Black [10.0%], 79 398 Hispanic [15.0%], and 307 439 non-Hispanic White [58.1%]; median [IQR] age, 67.0 [54.0-79.0] years), there were 13 843 HA-VTE events (1.2% of admissions) occurring in 10 410 patients (2.0%). HA-VTE events increased from 307 of 29 095 hospitalizations (1.1%) in the first quarter of 2013 to 551 of 33 729 hospitalizations (1.6%) in the first quarter of 2021. Among all HA-VTE events, 10 746 events (77.6%) were first noted after discharge. In multivariable analyses, several factors were associated with increased odds of HA-VTE, including active cancer (adjusted odds ratio [aOR], 1.96; 95% CI, 1.85-2.08), prior VTE (aOR, 1.71; 95% CI, 1.63-1.79), and reduced mobility (aOR, 1.63; 95% CI, 1.50-1.77). Factors associated with decreased likelihood of HA-VTE included Asian race (vs non-Hispanic White: aOR, 0.65; 95% CI, 0.61-0.69), current admission for suspected stroke (aOR, 0.73; 95% CI, 0.65-0.81), and Hispanic ethnicity (vs non-Hispanic White: aOR, 0.81; 95% CI, 0.77-0.86). HA-VTE events were associated with increased risk of readmission (hazard ratio [HR], 3.33; 95% CI, 3.25-3.41) and mortality (HR, 1.63; 95% CI, 1.57-1.70).Conclusions and RelevanceThis study found that HA-VTE events occurred in 1.2% of medical admissions, increased over time, and were associated with increased adverse outcomes. These findings suggest that approaches designed to mitigate occurrence and outcomes associated with HA-VTE may remain needed.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

et al. 2022

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“…One of these patients had iron deficiency anemia, a condition that is considered a rare cause of thrombosis by some authors. 15 In addition to that, she was taking combined oral contraceptives, which are well-known prothrombotic risk factors 16 and thus might have also contributed to thrombogenesis in this case. However, the common use of these medications makes their contributory role arguable.…”

Section: Cerebral Venous Sinus Thrombosismentioning

confidence: 84%

Serious neurological adverse events following immunization against SARS-CoV-2: a narrative review of the literature

Eslait-Olaciregui,

Llinás-Caballero,

Patiño-Manjarrés

et al. 2023

Therapeutic Advances in Drug Safety

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Amid the coronavirus disease 2019 (COVID-19) pandemic, massive immunization campaigns became the most promising public health measure. During clinical trials, certain neurological adverse effects following immunization (AEFIs) were observed; however, acceptable safety profiles lead to emergency authorization for the distribution and use of the vaccines. To contribute to pharmacovigilance and lessen the potential negative impact that vaccine hesitancy would have on immunization programs, we conducted a review of the scientific literature concerning the epidemiological data, clinical presentation, and potential mechanisms of these neurological AEFIs. There is some epidemiological evidence linking COVID-19 vaccines to cerebral venous sinus thrombosis, arterial ischemic stroke, convulsive disorder, Guillain–Barré syndrome, facial nerve palsy, and other neurological conditions. Cerebral venous sinus thrombosis has been associated with a thrombotic thrombocytopenia induced by the vaccine, similar to that induced by heparin, which suggests similar pathogenic mechanisms (likely involving antibodies against platelet factor 4, a chemokine released from activated platelets). Arterial ischemic stroke is another thrombotic condition observed among some COVID-19 vaccine recipients. Vaccine-induced convulsive disorder might be the result of structural abnormalities potentially caused by the vaccine or autoimmune mechanisms. Guillain–Barré syndrome and facial nerve palsy may also be linked to the immunization event, possibly due to immune mechanisms such as uncontrolled cytokine release, autoantibody production, or bystander effect. However, these events are mostly uncommon and the evidence for the association with the vaccine is not conclusive. Furthermore, the potential pathophysiological mechanisms remain largely unknown. Nevertheless, neurological AEFIs can be serious, life-threatening or even fatal. In sum, COVID-19 vaccines are generally safe and the risk of neurological AEFIs does not outweigh the benefits of immunization. However, early diagnosis and treatment of neurological AEFIs are of utmost importance, and both health professionals and the public should be aware of these conditions.

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“…During pregnancy, the equilibrium state between the fibrinolytic and hemostatic systems changes in favor of the prothrombotic status to prevent major bleeding during pregnancy and delivery [ 9 ]. Thrombocytosis is caused by anemia associated with pregnancy and childbirth, which can cause thrombosis [ 10 ], several articles have shown a link between CVT and iron deficiency, with anemia playing a consistent role in the development of CVT [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Challenges in Cerebral Venous Thrombosis Management—Case Reports and Short Literature Review

Pleşa

Jijie²,

Toma³

et al. 2023

Life

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Cerebral venous thrombosis (CVT) is a rare type of stroke, with a complex clinical presentation that can make it a diagnostic challenge for the swift initiation of anticoagulation. When a hemorrhagic transformation is added, therapeutic management becomes even more complex. We describe a series of four cases, aged between 23 and 37 years old, with cerebral venous thrombosis. They were admitted to our clinic between 2014 and 2022. All cases presented significant challenges in either diagnostic, therapeutic or etiologic evaluation, at different stages of the disease. Late complications such as epilepsy or depression and other behavioral disorders represent long-term sequelae for the patient. Therefore, through its late complications, CVT is not only an acute disease but a chronic disorder with long-term follow-up requirements. The first case of the series is of a postpartum woman with focal neurological deficit caused by CVT with hemorrhagic transformation that presented multiple thrombotic complications and severe depression. The second case is of a man with extensive cerebral thrombosis who developed bilateral papillary edema under therapeutic anticoagulation treatment. The third case is of a woman with bilateral cavernous sinus thrombosis who later developed depressive disorder and focal seizures. The fourth case is of a pregnant woman in the first trimester presenting with a steep decline in consciousness level secondary to deep cerebral vein thrombosis requiring intensive care and subsequently developing a memory disorder. For a long period of time, due to being underdiagnosed, few things were known about CVT. Nowadays, we have all the tools to diagnose, treat, and follow up cases of CVT.

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Iron Deficiency Anemia as a Rare Risk Factor for Recurrent Pulmonary Embolism and Deep Vein Thrombosis

Cited by 10 publications

References 7 publications

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

Serious neurological adverse events following immunization against SARS-CoV-2: a narrative review of the literature

Challenges in Cerebral Venous Thrombosis Management—Case Reports and Short Literature Review

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