Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study

Abstract

BackgroundVenous thromboembolism (VTE) is a common complication during and after a hospital admission. Although it is mainly considered a complication of surgery, it often occurs in people who have not undergone surgery, with recent evidence suggesting that immune-mediated diseases may play a role in VTE risk. We, therefore, decided to study the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in people admitted to hospital with a range of immune-mediated diseases.MethodsWe analysed databases of linked statistical records of hospital admissions and death certificates for the Oxford Record Linkage Study area (ORLS1:1968 to 1998 and ORLS2:1999 to 2008) and the whole of England (1999 to 2008). Rate ratios for VTE were determined, comparing immune-mediated disease cohorts with comparison cohorts.ResultsSignificantly elevated risks of VTE were found, in all three populations studied, in people with a hospital record of admission for autoimmune haemolytic anaemia, chronic active hepatitis, dermatomyositis/polymyositis, type 1 diabetes mellitus, multiple sclerosis, myasthenia gravis, myxoedema, pemphigus/pemphigoid, polyarteritis nodosa, psoriasis, rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus. Rate ratios were considerably higher for some of these diseases than others: for example, for systemic lupus erythematosus the rate ratios were 3.61 (2.36 to 5.31) in the ORLS1 population, 4.60 (3.19 to 6.43) in ORLS2 and 3.71 (3.43 to 4.02) in the England dataset.ConclusionsPeople admitted to hospital with immune-mediated diseases may be at an increased risk of subsequent VTE. Our findings need independent confirmation or refutation; but, if confirmed, there may be a role for thromboprophylaxis in some patients with these diseases.

Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides

“…A few populationbased epidemiological studies have been performed in Europe and the United States. Ramagopalan 8 Zöller et al reported a study on risk of PE in patients with autoimmune disease from Sweden. The MigMed2 database containing information about all registered residents of Sweden from 1964-2008 was used.…”

“…5 Recent large-scale epidemiological studies have highlighted systemic autoimmune diseases as a risk factor for VTE. [6][7][8] This article aims to touch upon VTE among patients with systemic autoimmune diseases and to discuss the occurrence of this condition among patients with primary systemic vasculitides (PSV). Since the literature on VTE in patients with PSV is scarce, mechanisms pertaining to other systemic autoimmune diseases have been hypothetically extrapolated to patients with PSV.…”

Coeliac disease and risk of venous thromboembolism: a nationwide population‐based case‐control study

“…deep vein thrombosis (DVT) and its complication pulmonary embolism (PE), because they are reported to have hyperhomocysteinaemia, low levels of K-vitamin-dependent anticoagulant proteins, and increased levels of thrombin-activatable fibrinolysis inhibitor (Halfdanarson et al, 2007). There are several case reports regarding VTE occurrence in CD patients (Daum et al, 2009;Halfdanarson et al, 2007), but observational studies present conflicting results and may have been confounded by medication use and several comorbidities (Ludvigsson et al, 2007;Miehsler et al, 2004;Ramagopalan et al, 2011).…”

Autoimmune Hemolytic Anemia Confers an Independent Risk Factor for Thrombosis: Retrospective Cohort Study Using the “STRIDE” Database

“…Prior studies have been smaller in size or descriptive [5,26,27], done in the context of specific hyper coagulable states [28,29], or with a design that excluded secondary AIHA patients or lacked anon-AIHA cohort matched for relevant AIHA risk factors [14][15][16][17]19,20].…”

“…However, the studies included the meta-analysis were limited in the extent to which they matched their AIHA and non-AIHA cohorts. Yusuf, et al matched their non-AIHA cohort according to age and gender alone [14], while the other three studies required their non-AIHA cohort to only lack a diagnosis of AIHA [15][16][17].…”