Risk of venous thromboembolism occurrence among adults with selected autoimmune diseases: A study among a U.S. cohort of commercial insurance enrollees

Abstract

Objective This study assessed the risk of venous thromboembolism (VTE) among privately insured adults in the U.S. with one or more of the following autoimmune diseases: autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Materials and Methods Using the Truven Health MarketScan® Databases, patients 18–64 years of age with a diagnosis of AIHA, ITP, RA, or SLE in 2007 and a sex and age-group matched comparison group of enrollees were followed up through 2010 to identify VTE events. Survival curve and Cox proportional hazards analyses were conducted to assess differences between groups. Results Among patients with AIHA, ITP, RA, or SLE, or >1 of these diseases, the risk of at least one VTE event was 19.74, 7.72, 4.90, 9.89, and 13.35 per 1,000 person-years, respectively; among the comparison group, the risk was 1.91 per 1,000 person-years. The adjusted hazard ratios (aHRs) for VTE among patients with AIHA, ITP, RA, or SLE, or >1 of these diseases (when compared with the comparison group) tended to decline over follow-up time; at 1 year, the aHRs were 6.30 (95% confidence interval [CI]: 4.44–8.94), 2.95 (95% CI: 2.18–4.00), 2.13 (95% CI: 1.89–2.40), 4.68 (95% CI: 4.10–5.33), and 5.11 (95% CI: 4.26–6.14), respectively. Conclusion Having AIHA, ITP, RA, or SLE, or >1 of these diseases was associated with an increased likelihood of a VTE event. More research is necessary to develop better understanding of VTE occurrence among people with autoimmune diseases.

Cold agglutinin disease burden: a longitudinal analysis of anemia, medications, transfusions, and health care utilization

“…44 A meta-analysis of several AIHA cohorts observed a significantly increased risk of thrombotic events among AIHA patients [45][46][47][48] which have been linked to cause of death. 49,50 In the CAD literature, thrombotic events were reported in Prabhu et al 28 (1 cerebral venous thrombosis event among 12 patients) and Roth et al 32 (7 events in 4 patients, including 1 pulmonary embolism), which are comparable to our 5 thrombotic events in 29 patients.…”

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].…”

Postoperative Risk of Venous Thromboembolism in Rheumatic Disease Patients

“…Patients with rheumatic diseases are at higher risk of VTE than the general population [26,27] particularly after hospitalization for their rheumatic disease [10•, 11]. Ramagopalan et al examined administrative data from the British National Health Service and demonstrated that the rate of VTE after hospital discharge was approximately 1.5-2-fold higher in patients admitted for ankylosing spondylitis, rheumatoid arthritis (RA), Sjogren's, or scleroderma and approximately 3-4.5-fold higher in patients admitted for dermatomyositis/polymyositis (DM/PM), polyarteritis nodosa (PAN), or systemic lupus erythematosus (SLE) in comparison to patients admitted for minor medical or surgical conditions [10•].…”