Sex Difference in Risk of Second but Not of First Venous Thrombosis

Roach, Rachel E J; Lijfering, Willem M.; Rosendaal, Frits R.; Cannegieter, Suzanne C.; Cessie, Saskia le

doi:10.1161/circulationaha.113.004768

Cited by 125 publications

(97 citation statements)

References 30 publications

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“…23 The higher risk in men than in women of recurrent VTE has been recognized for some time, 24 but only recently has it become clear that this disparity in risk also exists for first events. 25 Although the cause of the risk difference between the genders is not yet known, our results are in line with these findings.…”

Section: Discussionsupporting

confidence: 91%

Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

Cannegieter

Horváth‐Puhó

Schmidt

et al. 2015

Blood

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Key Points• In the 3 months after isolated SVT, the risk of a deep venous event or pulmonary embolism is 3.4%.• This risk remains fivefold increased more than 5 years after the superficial event.Recently, it has become apparent that superficial vein thrombosis (SVT) can have serious complications. However, the magnitude of the risk of subsequent deep venous and arterial thrombotic events remains unknown. We examined this in a nationwide population-based setting during a period when SVT was not treated routinely with anticoagulants. The Danish National Registry of Patients, covering all Danish hospitals, was used to identify 10 973 patients with a first-time diagnosis of SVT between 1980 and 2012. A comparison cohort of 515 067 subjects, matched by age, gender, and calendar year, was selected from the general Danish population. Outcomes were venous thromboembolism, acute myocardial infarction, ischemic stroke, and death. During median follow-up of 7 years, the incidence rate of venous thromboembolism was 18.0/1000 person-years (95% confidence interval [CI], 17.2-18.9). The highest risk occurred in the first 3 months (3.4%; 95% CI, 3.0-3.7). Compared with the general population, the hazard ratio was 71.4 (95% CI, 60.2-84.7) in this period, steadily decreasing to 5.1 (95% CI 4.6-5.5), 5 years after the SVT. The hazard ratios for acute myocardial infarction, stroke, and death were 1.2 (95% CI, 1.1-1.3), 1.3 (95% CI, 1.2-1.4), and 1.3 (95% CI, 1.2-1.3), respectively, with the highest risk also shortly after SVT. These data indicate the prognostic importance of SVT and may form the basis for clinical decisionmaking regarding anticoagulation. (Blood. 2015;125(2):229-235)

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Section: Discussionsupporting

confidence: 91%

Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

Cannegieter

Horváth‐Puhó

Schmidt

et al. 2015

Blood

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“…In contrast, elevated factor VIII activity has not been previously identified as a risk factor for VTE in glioma patients, although factor VIII activity has been associated with VTE in other patient populations [28, 30]. Likewise, male gender, a VTE risk factor in GBM patients in our study, is a novel finding in glioma patients but has been identified as VTE risk factor in the general population [31, 32]. …”

Section: Discussioncontrasting

confidence: 75%

A prospective multicenter study of venous thromboembolism in patients with newly-diagnosed high-grade glioma: hazard rate and risk factors

Streiff

Kickler

et al. 2015

J Neurooncol

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Venous thromboembolism (VTE) is a common complication in patients with high-grade gliomas. The purpose of this prospective multicenter study was to determine the hazard rate of first symptomatic VTE in newly-diagnosed glioma patients and identify clinical and laboratory risk factors. On enrollment, demographic and clinical information were recorded and a comprehensive coagulation evaluation was performed. Patients were followed until death. The study end point was objectively-documented symptomatic VTE. One hundred seven patients were enrolled with a median age of 57 years (range 29–85) between June 2005 and April 2008. Ninety-one (85 %) had glioblastoma multiforme (GBM). During an average survival of 17.7 months, 26 patients (24 %) (95 % CI 17–34 %) developed VTE (hazard rate 0.15 per person-year) and 94 patients (88 %) died. Median time to VTE was 14.2 weeks post-operation (range 3–126). Patients with an initial tumor biopsy were 3.0 fold more likely to suffer VTE (p = 0.02). Patients with an elevated factor VIII activity (>147 %) were 2.1-fold more likely to develop VTE. ABO blood group, D dimer and thrombin generation were not associated with VTE. No fatal VTE occurred. VTE is a common complication in patients with newly-diagnosed high grade gliomas, particularly in the first six months after diagnosis. Patients with an initial tumor biopsy and elevated factor VIII levels are at increased risk. However, VTE was not judged to be pri-marily responsible for any patient deaths. Therefore, out-patient primary VTE prophylaxis remains investigational until more effective primary prophylaxis strategies and therapies for glioma are identified.

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“…However, limiting our analysis to patients above 45 years of age where hormonally induced VTE in women is unlikely, male sex is still a strong risk factor for a subsequent cancer diagnose. One recent study [18] found an increased risk for first time VTE among men compared to females if female reproductive factors are taken into account. Here they discussed differences in genetic factors as one possible explanation.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism and cancer risk

Sandén

Svensson²,

Själander

2016

J Thromb Thrombolysis

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Cancer increases the risk of venous thromboembolism (VTE) and about 20 % of all VTE are associated with cancer. VTE can also be used as a marker for occult cancer. The objective was to examine the correlation between VTE and cancer regarding predictors for a subsequent cancer diagnosis. Patients treated for VTE between January 1st 2006 and December 31th 2011 were extracted from the Swedish national quality register AuriculA and crossmatched with the Swedish National Patient Register. In total 7854 patients corresponding to 14284 treatments years were examined. Primary VTE was found in 6451 patients, with 3936 first and 2515 recurrent VTE. There were 1403 patients with secondary VTE. After a first or recurrent primary VTE the incidence of cancer diagnose was high being 9.4–10.0 % the first year compared to 2.7–2.5 % during the second year. Cancer in the digestive organs was the most common type of cancer among those with first primary VTE with 19.2 % of diagnoses. In multivariable analysis age was found to increase the risk of cancer diagnosis after both first and recurrent primary VTE HR 1.02 (CI 1.02–1.03) and HR 1.02 (CI 1.01–1.03). For a first primary VTE anemia HR 2.13 (CI 1.48–3.08) and male sex HR 1.38 (CI 1.09–1.76) increased the risk while hypertension HR 0.74 (0.57–0.96), dementia HR 0.30 (CI 0.10–0.95) and history of major bleeding HR 0.52 (CI 0.28–0.97) reduced the risk of a subsequent cancer diagnosis. There is a substantial proportion of patients being diagnosed with cancer the first year after a primary VTE, anaemia and male sex confers an increased risk.

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Sex Difference in Risk of Second but Not of First Venous Thrombosis

Cited by 125 publications

References 30 publications

Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

A prospective multicenter study of venous thromboembolism in patients with newly-diagnosed high-grade glioma: hazard rate and risk factors

Venous thromboembolism and cancer risk

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