Elevated albuminuria associated with increased risk of recurrent venous thromboembolism: results of a population-based cohort study

SUMMARY To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32–219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44–267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49–15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.

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Risk of a permanent work-related disability pension after incident venous thromboembolism in Denmark: A population-based cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003770 ◽

2021 ◽

Vol 18 (8) ◽

pp. e1003770

Author(s):

Helle Jørgensen ◽

Erzsébet Horváth-Puhó ◽

Kristina Laugesen ◽

Sigrid Brækkan ◽

John-Bjarne Hansen ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Cardiovascular Diseases ◽

General Population ◽

Disability Pension ◽

Population Based ◽

Social Consequences ◽

Work Related ◽

Increased Risk ◽

Permanent Work

Background Long-term complications of venous thromboembolism (VTE) hamper physical function and impair quality of life; still, it remains unclear whether VTE is associated with risk of permanent work-related disability. We aimed to assess the association between VTE and the risk of receiving a permanent work-related disability pension and to assess whether this association was explained by comorbidities such as cancer and arterial cardiovascular disease. Methods and findings A Danish nationwide population-based cohort study consisting of 43,769 individuals aged 25 to 66 years with incident VTE during 1995 to 2016 and 218,845 birth year-, sex-, and calendar year-matched individuals from the general population, among whom 45.9% (N = 120,540) were women, was established using Danish national registries. The cohorts were followed throughout 2016, with permanent work-related disability pension as the outcome. Hazard ratios (HRs) with 95% confidence intervals (CIs) for disability pension were computed and stratified by sex and age groups (25 to 34, 35 to 44, 45 to 54, and 55 to 66 years of age) and adjusted for comorbidities and socioeconomic variables. Permanent work-related disability pensions were granted to 4,415 individuals with VTE and 9,237 comparison cohort members (incidence rates = 17.8 and 6.2 per 1,000 person-years, respectively). VTE was associated with a 3-fold (HR 3.0, 95% CI: 2.8 to 3.1) higher risk of receiving a disability pension. Adjustments for socioeconomic status and comorbidities such as cancer and cardiovascular diseases reduced the estimate (HR 2.3, 95% CI: 2.2 to 2.4). The risk of disability pension receipt was slightly higher in men than in women (HR 2.5, 95% CI: 2.3 to 2.6 versus HR 2.1, 95% CI: 2.0 to 2.3). As this study is based on medical and administrative registers, information on post-VTE care, individual health behavior, and workplace factors linked to disability pension in the general population are lacking. Furthermore, as disability pension schemes vary, our results might not be directly generalizable to other countries or time periods. Conclusions In this study, incident VTE was associated with increased risk of subsequent permanent work-related disability, and this association was still observed after accounting for comorbidities such as cancer and cardiovascular diseases. Our results emphasize the social consequences of VTE and may help occupational and healthcare professionals to identify vulnerable individuals at risk of permanent exclusion from the labor market after a VTE event.

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Inherited Thrombophilias Are Associated with an Increased Risk of COVID-19 Associated Venous Thromboembolism: A Prospective Population-Based Cohort Study

Blood ◽

10.1182/blood-2021-149841 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3214-3214

Author(s):

Hannah P Stevens ◽

Rodrigo Canovas ◽

Karlheinz Peter ◽

Huyen Tran ◽

Zane Kaplan ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Population Based ◽

Uk Biobank ◽

Factor V Leiden Mutation ◽

Genome Wide ◽

A Genome ◽

Increased Risk ◽

Icd 10 ◽

The Impact

Abstract Background: COVID-19 is associated with high rates of venous thromboembolism (VTE). The impact of common inherited thrombophilias on the development of COVID-19-associated VTE (COVID-19 VTE) is not well understood. Objective: To determine if the presence of inherited thrombophilias modifies the risk of COVID-19 VTE or COVID-19 mortality. Methods: Prospective population-based cohort study evaluating adult participants of the UK Biobank diagnosed with COVID-19 between November 2019 and May 2021. Individuals were of European descent and aged between 45 and 69 at recruitment to UK Biobank. We evaluated six single nucleotide polymorphisms including rs6025 (Factor V Leiden mutation) and rs1799963 (Prothrombin mutation) in addition to two polygenic risk scores (PRS-VTE and PRS-ABO). A genome-wide association study was performed for associations with COVID-19 VTE. COVID-19 VTE was defined using International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for VTE following COVID-19 diagnosis. COVID-19 mortality was defined using ICD-10 codes for COVID-19 on the death certificate. Results: Demographic and clinical characteristics are shown in Table 1. Of the 13 712 COVID-19 positive individuals included in the analysis, the median age was 54 years and 52.5% were female. There were 197 (1.4%) cases of COVID-19 VTE and 890 (6.5%) died due to COVID-19. The rs6025 variant, synonymous with FVL, was associated with a 1.8-fold risk of COVID-19 VTE (95% CI 1.040-2.931) (Table 2). The risk of COVID-VTE was also increased with rs2066865 (OR 1.345; 95% CI 1.074-1.675) and the PRS-VTE (OR 1.262; 95% CI 1.081-1.468) (Table 2). COVID-19 VTE was associated with increased COVID-19 mortality (OR 2.731; 95% CI 1.885-3.901) but this study found no association between the studied inherited thrombophilias and COVID-19 mortality (Table 2). On genome-wide analysis, two novel SNPs, rs4975019 and rs2875853, located on chromosomes 4 and 16 respectively, were associated with an increased occurrence of COVID-19 VTE. Conclusions: These data demonstrate that several inherited thrombophilias increase the risk of COVID-19 VTE and suggest that two novel SNPs are associated with COVID-19 VTE. These results suggest that certain inherited thrombophilias may assist in characterising a subgroup of COVID-19 patients at higher risk of thrombotic events who require individualised antithrombotic therapy. Future prospective studies are required to evaluate inherited thrombophilias in this patient cohort. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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The Occurrence of Subsequent Malignancy in Patients Presenting with Deep Vein Thrombosis: Results from a Historical Cohort Study

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614211 ◽

1998 ◽

Vol 79 (01) ◽

pp. 19-22 ◽

Cited By ~ 29

Author(s):

Raghu Rajan ◽

Michael Gent ◽

Jack Hirsh ◽

William Geerts ◽

Peter Skingley ◽

...

Keyword(s):

Cohort Study ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Oral Anticoagulant Therapy ◽

Historical Cohort ◽

Vein Thrombosis ◽

Historical Cohort Study ◽

Increased Risk ◽

Recurrent Venous Thromboembolism ◽

Deep Vein

SummaryBackground: Several studies have reported that patients who present with idiopathic deep vein thrombosis (DVT) have an increased risk of subsequently developing cancer. A clinical trial had previously been conducted examining the optimal duration of oral anticoagulant therapy following initial heparin treatment in patients with proximal DVT.Methods: A historical cohort study was performed on patients enrolled in the duration of anticoagulant trial. Patients known to have cancer at the time of entry into the trial were excluded. The qualifying DVTs were classified as idiopathic (no known associated risk factors) or secondary without knowledge of subsequent recurrent venous thrombosis or cancer. The patients were then followed for the development of cancer.Results: Thirteen (8.6%) of the 152 patients in the idiopathic cohort subsequently developed cancer compared to eight (7.1%) of 112 patients in the secondary cohort, P = 0.86. Two (5.4%) of 37 patients with recurrent venous thromboembolism and 19 (8.4%) of 227 patients without recurrent thromboembolism developed cancer, P = 0.7.Conclusion: Our study did not detect an increased risk of subsequent cancer in patients presenting with idiopathic DVT compared to secondary DVT; nor did we detect an increased incidence of cancer in patients with recurrent venous thromboembolism. Further studies are required prior to pursuing a policy of aggressive screening for cancer in patients with idiopathic venous thromboembolism.

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Type 1 diabetes is associated with an increased risk of venous thromboembolism: A retrospective population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0226997 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0226997 ◽

Cited By ~ 5

Author(s):

Yi-Hao Peng ◽

Yu-Sheng Lin ◽

Chia-Hung Chen ◽

Kun-Yuan Tsai ◽

Yi-Chih Hung ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Venous Thromboembolism ◽

Population Based ◽

Increased Risk

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Blood Transfusion and Risk of Venous Thromboembolism: A Population-Based Cohort Study

Thrombosis and Haemostasis ◽

10.1055/s-0039-1697664 ◽

2019 ◽

Vol 120 (01) ◽

pp. 156-167 ◽

Cited By ~ 2

Author(s):

Shih-Yi Lin ◽

Yun-Lung Chang ◽

Hung-Chieh Yeh ◽

Cheng-Li Lin ◽

Chia-Hung Kao

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Blood Transfusion ◽

Population Based ◽

Red Blood Cell Transfusion ◽

Research Database ◽

Control Cohort ◽

Vein Thrombosis ◽

Increased Risk ◽

Cox Proportional Hazard Models

Abstract Background The risk of venous thromboembolism (VTE) in generally ill patients, both under outpatient and inpatient care, following blood transfusion has not been determined. Methods This retrospective population-based cohort study was conducted using the National Health Insurance Research Database. We studied patients who received blood transfusion, defined as red blood cell transfusion of any type, from January 1, 2000 to December 31, 2011. The index date was defined as the date of blood transfusion. The primary outcome was VTE. Propensity score matching and Cox proportional hazard models were used. Results A total of 41,866 patients who underwent blood transfusion and 41,866 matched controls were studied. Generally, the blood transfusion cohort has 2.98 times higher risk of VTE than the control cohort (95% confidence interval [CI] = 1.23–7.22). The blood transfusion cohort had respectively 1.99 and 1.64 times higher risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) compared with the control cohort (DVT, 95% CI = 1.65–2.41; PE, 95% CI = 1.19–2.26). Patients in the blood transfusion cohort who did not use warfarin were 1.95 times more likely to develop VTE than those in the control cohort (adjusted hazard ratio [HR]: 1.95, 95% CI = 1.65–2.31). Patients in the blood transfusion cohort were 1.74 times more likely to die than those in the control cohort (adjusted HR: 1.74, 95% CI = 1.48–2.05). Conclusion Blood transfusion is associated with an increased risk of VTE. The risk of VTE decreased in those who took warfarin.

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Hypothyroidism and the Risk of Venous Thromboembolism: A Nationwide Cohort Study

Thrombosis and Haemostasis ◽

10.1055/s-0039-3402761 ◽

2020 ◽

Vol 120 (03) ◽

pp. 505-514 ◽

Cited By ~ 1

Author(s):

Wei-Ting Wei ◽

Peter Pin-Sung Liu ◽

Shu-Man Lin ◽

Carol Chiung-Hui Peng ◽

Jen-Hung Wang ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Population Based ◽

Significant Trend ◽

Research Database ◽

Exact Matching ◽

Increased Risk ◽

Competing Risk Models ◽

Thyroxine Replacement Therapy ◽

Hypothyroid Patients

Abstract Background Previous studies have shown that hypothyroidism may have an impact on blood coagulation. However, how hypothyroidism and thyroxine replacement therapy (TRT) affect the risk of venous thromboembolism (VTE) remains controversial. This study aimed to examine the associations of hypothyroidism and TRT with VTE risks. Materials and Methods This nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. We enrolled 10,818 hypothyroid patients (the exposed cohort) and 21,636 non-hypothyroid subjects (the unexposed cohort) between 2001 and 2014 after 1:2 exact matching according to age, sex, and index year. Hypothyroid patients were further divided into two groups depending on whether they received TRT or not. Adjusted hazard ratios (aHRs) for VTE were calculated using Fine and Gray competing risk models. Results The mean follow-up period was 7.5 years. Hypothyroidism was significantly associated with a higher risk of VTE (aHR = 1.83 [95% confidence interval [CI]: 1.44–2.33, p < 0.001]). Among hypothyroid patients, the TRT subgroup had a non-significant trend of lower VTE risk than the non-TRT subgroup (aHR = 0.73 [95% CI: 0.52–1.01, p = 0.058]). The analysis for individual events revealed a significant association between TRT use and a lower risk of pulmonary embolism among hypothyroid patients (aHR = 0.34 [95% CI: 0.13–0.88, p = 0.026]). Conclusion The data suggest that hypothyroidism was significantly associated with an increased risk of VTE. Among hypothyroid patients, a non-significant trend of lower VTE risk in patients treated with TRT was observed. Further prospective studies or clinical trials are necessary to confirm causality.

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Venous Thromboembolism and Risk of Cancer in Patients with Dementia: A Danish Population-Based Cohort Study

Journal of Alzheimer s Disease ◽

10.3233/jad-201530 ◽

2021 ◽

pp. 1-13

Author(s):

Cecilia H. Fuglsang ◽

David Nagy ◽

Frederikke S. Troelsen ◽

Dora K. Farkas ◽

Victor W. Henderson ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

General Population ◽

Confidence Interval ◽

Absolute Risk ◽

Population Based ◽

First Year ◽

People With Dementia ◽

Increased Risk ◽

Risk Of Cancer

Background: Venous thromboembolism (VTE) may be the first manifestation of occult cancer. Dementia has been linked to reduced cancer risk. Objective: We examined the risk of cancer following VTE in people with dementia in comparison to the risk in the general population. Methods: We conducted a population-based Danish registry-based cohort study following patients with a first-time VTE and a previous or concurrent diagnosis of dementia during the period 1 April 1996 –31 December 2017. We followed the study participants from date of VTE until diagnosis of cancer, death, emigration, or end of study period, whichever came first. The absolute risk of cancer within one year after VTE was computed, treating death as a competing risk. We calculated gender, age, and calendar-period standardized incidence ratios (SIRs) of cancer based on national cancer rates. Results: We followed 3,552 people with dementia and VTE for a median of 1.3 years. Within the first year after VTE, they had a 90%increased risk of cancer in comparison with the general population [SIR: 1.9 (95%confidence interval: 1.6–2.4)]. During subsequent follow-up years, the SIR fell to 0.7 (95%confidence interval: 0.5–0.8). Findings for Alzheimer’s disease and VTE were similar. Conclusion: People with dementia have an increased risk of a cancer diagnosis during the first year following VTE, perhaps related to increased surveillance, and a lower risk thereafter. Overall risk is similar to that of the general population.

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