Risk of venous thromboembolism with rheumatoid arthritis

Abstract

Rheumatoid arthritis is not generally considered to be a risk factor for venous thromboembolism (VTE), although abnormalities of coagulation factors have been found in patients with rheumatoid arthritis. Sparse data in a few patients suggest that patients with rheumatoid arthritis may have higher rates of VTE. The purpose of this investigation was to determine if the incidences of pulmonary embolism (PE) and deep venous thrombosis (DVT) are increased in hospitalized patients with rheumatoid arthritis. The number of patients discharged from non-Federal short-stay hospitals throughout the United States from 1979 through 2005 with a discharge code for rheumatoid arthritis was obtained from the National Hospital Discharge Survey (NHDS). Among hospitalized patients with rheumatoid arthritis who did not have joint surgery, 41,000 of 4,818,000 (0.85%) had PE compared with 3,366,000 of 891,055,000 (0.38%) among patients who did not have rheumatoid arthritis and who did not have operations or joint surgery (relative risk = 2.25). Deep venous thrombosis was diagnosed in 79,000 of 4,818,000 (1.64%) patients with rheumatoid arthritis and no joint operation, versus 7,681,000 of 891,055,000 (0.86%) who did not have rheumatoid arthritis or a joint operation (relative risk = 1.90). The relative risk of venous thromboembolism (PE and/or DVT) in these patients was 1.99. The data suggest that rheumatoid arthritis is a risk factor for VTE in hospitalized medical patients. A heightened awareness of the risks for VTE and a lower threshold for evaluation of patients for possible DVT or PE would be appropriate in caring for hospitalized patients with rheumatoid arthritis.

Endothelium, venous thromboembolism and ischaemic cardiovascular events

“…Furthermore, the increased incidence of VTE in patients with risk factors for arterial cardiovascular events points too to a common pathogenesis (6). Indeed, a number of studies, with different design and in various clinical settings, have shown an increased risk of VTE associated with most of the classic or novel risk factor for ischaemic cardiovascular disease (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) (ǠTable 1).…”

“…In particular, acute reactions to infectious agents are associated with an increased risk of both arterial ischaemic events and VTE and are accompanied by both arterial and venous endothelial dysfunction (40,43,44); increased circulating levels of some biomarkers of endothelial dysfunction, like endothelial microparticles or P-selectin, are associated with both an enhanced risk of cardiovascular events and of VTE (45)(46)(47); recent data have shown in patients with VTE an increase of circulating fibronectin, an endothelium-released plasma factor previously shown to correlate with arterial endothelial dysfunction (48,49); several other clinical conditions characterised by an impaired arterial endothelial function, like airpollution, chronic HIV infection, a family history of myocardial infarction, the metabolic syndrome, rheumatoid arthritis and microalbuminuria, have been reported to be associated not only with an increased risk of arterial events but also of venous thrombosis (12,14,16,19,21,22,(50)(51)(52).…”

Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de comorbidades em pacientes com artrite reumatoide

“…74,75 The incidence of those comorbidities can be associated with classic risk factors that affect the general population and with specifi c aspects of RA. [74][75][76] In general, the following fi ndings contribute to increase the risk of thromboembolism: lower mobility consequent to joint lesions; hospitalizations with prolonged bed confi nement; more advanced age of most arthritic patients; compression of the venous system adjacent to a joint with huge joint effusion; and obesity.…”

“…74,75 The incidence of those comorbidities can be associated with classic risk factors that affect the general population and with specifi c aspects of RA. [74][75][76] In general, the following fi ndings contribute to increase the risk of thromboembolism: lower mobility consequent to joint lesions; hospitalizations with prolonged bed confi nement; more advanced age of most arthritic patients; compression of the venous system adjacent to a joint with huge joint effusion; and obesity. 74 Patients with RA have changes in the coagulation parameters and in the fi brinolytic system, 77 the most common fi ndings being as follows: increased platelet count; increased platelet activation markers; and increased thrombin markers, such as thrombin-antithrombin complexes and prothrombin fragments.…”

“…77,78 Although the studies on the prevalence of DVT and PTE in RA have shown discordant results, an important study has reported that RA is a risk factor for DVT and PTE. 75,79,80 That study has assessed the incidence of DVT and PTE in patients with RA hospitalized in the United States from 1979 to 2005. The results were as follows: 41,000 of 4,818,000 (0.85%) patients with RA had PTE, as compared with 3,366,000 of 891,055,000 (0.38%) patients without RA (RR = 2.25).…”