Hyperthyroidism as a Risk Factor for Venous Thromboembolism: A Case-Control Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5350-5350
Author(s):  
Bregje van Zaane ◽  
Alessandro Squizzato ◽  
Roeland Huijgen ◽  
Anton P van Zanten ◽  
Eric Fliers ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Serum Levels ◽  
Normal Range ◽  
Thromboembolic Risk ◽  
Venous Thromboembolic ◽  
A Prospective Study ◽  
Primary Hyperthyroidism ◽  
Overt Hyperthyroidism ◽  
Control Study

Abstract <>BACKGROUND: It has been hypothesized that overt hyperthyroidism may increase venous thromboembolic risk given substantiated evidence of a thyroid-induced hemostatic imbalance favoring a hypercoagulable state. Aim of this study was to investigate whether or not overt hyperthyroidism functions as a risk factor for venous thrombosis. <>METHODS: We performed laboratory measurement of thyroid function in 190 patients with objectively confirmed venous thrombosis of the lower extremities and 375 sex-matched controls drawn from a prospective study on general risk factors for venous thrombosis. <>FINDINGS: Of the 190 included cases, 155 patients were diagnosed with deep venous thrombosis (DVT), 12 patients with calfvein thrombosis and 23 with superficial thrombophlebitis. Undetected overt primary hyperthyroidism was found present in 3 DVT patients at the time of the event, whereas none was seen in controls (p=0.037, all thrombosis patients combined; p=0.024, DVT patients only). We found slightly higher levels of serum free thyroxine (fT4) in patients with venous thrombosis as compared to controls, and analysis of the proportion of cases with a higher fT4, above 16 pmol/L (75th percentile of values in controls), yielded an odds ratio of 1.7 for DVT to develop (95% CI 1.12–2.45 when adjusted for sex, age and known thyroid dysfunction). No such association was found for serum levels of thyrotropin or thyroidperoxidase antibodies. <>INTERPRETATION: Our data suggest overt hyperthyroidism to function as a risk factor for venous thrombosis. In addition, higher levels of fT4, even within the normal range, are associated with increased VTE risk.

scholarly journals APC-resistance Is a Risk Factor for Postoperative Thromboembolism in Elective Replacement of the Hip or Knee – A Prospective Study

1999 ◽  
Vol 81 (01) ◽  
pp. 18-21 ◽  
Author(s):  
Tom Lundahl ◽  
Lennart Nilsson ◽  
Christer Andersson ◽  
Tomas Lindahl
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Anticoagulant Activity ◽  
Activated Protein C ◽  
Thromboembolic Complication ◽  
Thromboembolic Complications ◽  
Pulmonary Scintigraphy ◽  
Apc Resistance ◽  
Venous Thromboembolic ◽  
A Prospective Study

SummaryPostoperative venous thromboembolic complications are commonly seen after total replacement of the hip or knee. Recently, an inherited defect with resistance to the anticoagulant activity of activated protein C (APC-resistance) has been detected. APC-resistance seems to be a common risk factor, especially in Sweden, and it increases the propensity for venous thrombosis. This study assesses the prevalence of APC-resistance in a general population and its clinical significance for patients undergoing surgery associated with a high risk of thromboembolic complications. In a prospective cohort study, we analysed for APC-resistance in 645 consecutive patients before elective replacement of the hip or knee at 3 hospitals in southern Sweden. Thromboprophylaxis with LMWH-heparin was given to all patients throughout the hospitalisation period. We recorded events of clinical thromboembolism for 3 months postoperatively. Venography, ultrasonography or pulmonary scintigraphy was requested by the clinicians according to the existing routines, i.e. only patients with symptoms of thromboembolism were examined. A thromboembolic complication was registered in 20 (3.1%) patients. Fifty per cent of the venous thrombi had a proximal location. Only 0.3% of the patients had verified pulmonary embolism. APC-resistance was found in 14.1% of the patients, of whom 9.9% had experienced postoperative thromboembolism compared with 2.0% of the patients without APC-resistance (p <0.0007). We conclude that APC-resistance is a frequent risk factor for symptomatic postoperative deep venous thrombosis with an estimated relative risk of 5.0 (95% confidence interval: from 1.9 to 12.9) in elective replacement of the hip or knee.

scholarly journals High Carbohydrate 19-9 Antigen Serum Levels in Patients with Nonmelanoma Skin Cancer and Primary Occult Cancer

Biomedicines ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. 265 ◽  
Author(s):  
Giulia Malaguarnera ◽  
Saverio Latteri ◽  
Roberto Madeddu ◽  
Vito Emanuele Catania ◽  
Gaetano Bertino ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Predictive Value ◽  
Case Control Study ◽  
Matched Control ◽  
Serum Levels ◽  
Normal Range ◽  
Skin Cancers ◽  
Increased Risk ◽  
Control Study ◽  
Melanoma Skin

Background: Non-melanoma skin cancers (NMSC), despite having a favourable prognosis, present an increased risk of occult malignancies. The aim of this study was the evaluation of the usefulness of the mucinous marker carbohydrate 19-9 antigen (CA 19-9) in the diagnosis of occult cancers. (1) Patients and Methods: This is a case control study in which 480 patients with NMSC and 480 matched control subjects with dermatitis were enrolled; 208 patients with NMSC showed upper-normal CA 19-9 values, and 272 showed under-normal CA 19-9 values. (2) Results: The 208 patients positive for CA 19-9 included 87 with basal cell carcinoma (BCC) and 121 with squamous cell carcinoma (SCC). The 272 patients negative for CA 19-9 included 107 with BCC and 165 with SCC. For the SCC patients, CA 19-9 serum levels were significant in 121 of the patients (positive), 66 of which were affected by cancer; CA 19-9 was within the normal range in 165 patients, of which 30 were diagnosed with cancer. In the SCC patients, the CA 19-9 sensitivity was 68%, the specificity was 70%, the positive predictive value (PPV) was 54% (95%) and the negative predictive value (NPV) was 81%. In the BCC patients, the CA 19-9 sensitivity was 70%, the specificity was 66%, the PPV was 48% and the NPV was 83%. In the dermatitis patients (controls), we observed 121 patients that were CA 19-9 positive, with 15 malignancies, and 359 CA 19-9-negative patients, with three malignancies. (3) Conclusions: To confirm the association between CA 19-9 and an elevated risk of malignancies in NMSC, prospective cohort studies should be performed.

scholarly journals COVID-19 is associated with higher risk of venous thrombosis, but not arterial thrombosis, compared with influenza: Insights from a large US cohort

2021 ◽  
Author(s):  
Andrew Ward ◽  
Ashish Sarraju ◽  
Donghyun Lee ◽  
Kanchan Bhasin ◽  
Sanchit Gad ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Arterial Thrombosis ◽  
Propensity Scores ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Thromboembolic Risk ◽  
Vein Thrombosis ◽  
Hazard Ratios ◽  
Venous Thromboembolic

Introduction Infection with SARS-CoV-2 is typically compared with influenza to contextualize its health risks. SARS-CoV-2 has been linked with coagulation disturbances including arterial thrombosis, leading to considerable interest in antithrombotic therapy for Coronavirus Disease 2019 (COVID-19). However, the independent thromboembolic risk of SARS-CoV-2 infection compared with influenza remains incompletely understood. We evaluated the adjusted risks of thromboembolic events after a diagnosis of COVID-19 compared with influenza in a large retrospective cohort. Methods We used a US-based electronic health record (EHR) dataset linked with insurance claims to identify adults diagnosed with COVID-19 between April 1, 2020 and October 31, 2020. We identified influenza patients diagnosed between October 1, 2018 and April 31, 2019. Primary outcomes [venous composite of pulmonary embolism (PE) and acute deep vein thrombosis (DVT); arterial composite of ischemic stroke and myocardial infarction (MI)] and secondary outcomes were assessed 90 days post-diagnosis. Propensity scores (PS) were calculated using demographic, clinical, and medication variables. PS-adjusted hazard ratios (HRs) were calculated using Cox proportional hazards regression. Results There were 417,975 COVID-19 patients (median age 57y, 61% women), and 345,934 influenza patients (median age 47y, 66% women). Compared with influenza, patients with COVID-19 had higher venous thromboembolic risk (HR 1.53, 95% CI 1.38-1.70), but not arterial thromboembolic risk (HR 1.02, 95% CI 0.95-1.10). Secondary analyses demonstrated similar risk for ischemic stroke (HR 1.11, 95% CI 0.98-1.25) and MI (HR 0.93, 95% CI 0.85-1.03) and higher risk for DVT (HR 1.36, 95% CI 1.19-1.56) and PE (HR 1.82, 95% CI 1.57-2.10) in patients with COVID-19. Conclusion In a large retrospective US cohort, COVID-19 was independently associated with higher 90-day risk for venous thrombosis, but not arterial thrombosis, as compared with influenza. These findings may inform crucial knowledge gaps regarding the specific thromboembolic risks of COVID-19.

scholarly journals COVID-19 is associated with higher risk of venous thrombosis, but not arterial thrombosis, compared with influenza: Insights from a large US cohort

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261786
Author(s):  
Andrew Ward ◽  
Ashish Sarraju ◽  
Donghyun Lee ◽  
Kanchan Bhasin ◽  
Sanchit Gad ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Arterial Thrombosis ◽  
Propensity Scores ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Thromboembolic Risk ◽  
Vein Thrombosis ◽  
Hazard Ratios ◽  
Venous Thromboembolic

Introduction Infection with SARS-CoV-2 is typically compared with influenza to contextualize its health risks. SARS-CoV-2 has been linked with coagulation disturbances including arterial thrombosis, leading to considerable interest in antithrombotic therapy for Coronavirus Disease 2019 (COVID-19). However, the independent thromboembolic risk of SARS-CoV-2 infection compared with influenza remains incompletely understood. We evaluated the adjusted risks of thromboembolic events after a diagnosis of COVID-19 compared with influenza in a large retrospective cohort. Methods We used a US-based electronic health record (EHR) dataset linked with insurance claims to identify adults diagnosed with COVID-19 between April 1, 2020 and October 31, 2020. We identified influenza patients diagnosed between October 1, 2018 and April 31, 2019. Primary outcomes [venous composite of pulmonary embolism (PE) and acute deep vein thrombosis (DVT); arterial composite of ischemic stroke and myocardial infarction (MI)] and secondary outcomes were assessed 90 days post-diagnosis. Propensity scores (PS) were calculated using demographic, clinical, and medication variables. PS-adjusted hazard ratios (HRs) were calculated using Cox proportional hazards regression. Results There were 417,975 COVID-19 patients (median age 57y, 61% women), and 345,934 influenza patients (median age 47y, 66% women). Compared with influenza, patients with COVID-19 had higher venous thromboembolic risk (HR 1.53, 95% CI 1.38–1.70), but not arterial thromboembolic risk (HR 1.02, 95% CI 0.95–1.10). Secondary analyses demonstrated similar risk for ischemic stroke (HR 1.11, 95% CI 0.98–1.25) and MI (HR 0.93, 95% CI 0.85–1.03) and higher risk for DVT (HR 1.36, 95% CI 1.19–1.56) and PE (HR 1.82, 95% CI 1.57–2.10) in patients with COVID-19. Conclusion In a large retrospective US cohort, COVID-19 was independently associated with higher 90-day risk for venous thrombosis, but not arterial thrombosis, as compared with influenza. These findings may inform crucial knowledge gaps regarding the specific thromboembolic risks of COVID-19.

Toxoplasma gondii as a possible risk factor for COVID-19 severity: a case-control study

2021 ◽  
Vol 30 (2) ◽  
pp. 125-132
Author(s):  
Shaimaa A. Sharaf-El-Deen ◽  
Fatma H. Shalan ◽  
Mohammed A. Agha ◽  
Reham M. Brakat
Keyword(s):  
Risk Factor ◽  
Case Control Study ◽  
Serum Levels ◽  
Common Complication ◽  
Chronic Infections ◽  
Immune Exhaustion ◽  
Programmed Death ◽  
Programmed Death 1 ◽  
Almost All ◽  
Control Study

Background: COVID-19 is a worldwide pandemic that stroke almost all countries of the world causing thousands of deaths and disabilities and burdened the economy of countries. One of the main criteria of the immune response against COVID-19 is the “immune exhaustion”, due to increased expression of T cell suppressor molecules e.g. programmed death-1 (PD-1), that leads to flaring of viral multiplication and disastrous clinical outcomes. This immune exhaustion is not restricted to COVID-19 but is also a common complication of chronic infections with the widely spreading protozoan, Toxoplasma (T.) gondii. Thus, theoretically, the toxoplasmosis-associated immune exhaustion can worsen that of COVID-19 and consequently increases its severity. However, the studies on this theory are still insufficient. Objective: this work was designed to answer two questions. Does T. gondii co-infection affect the severity of COVID-19 manifestations? Is this action related to T. gondii-induced PD-1 changes? Methodology: Covid-19+ patients with moderate and severe conditions were screened for T. gondii IgG and compared to healthy controls. Serum levels of IL-1β, IL-6, TNFα, IFNγ, IL-1α cytokines were assessed to evaluate COVID-19 severity and prognosis. Lymphocytic expression of PD-1 was assessed by flowcytometry. Results: We recorded a higher incidence of toxoplasmosis among COVID-19 patients especially patients with severe/critical manifestations. T. gondii positive cases exhibited a statistically significant increase in lymphocytic expression of PD-1 that correlated positively with the proinflammatory and bad prognosis cytokines. With fixation of other risk factors for severity, toxoplasmosis still scored a significant value. Conclusion: toxoplasmosis increased the severity of COVID-19. These effects can be related to the Toxoplasmaassociated increased lymphocytic PD-1 expression. So, toxoplasmosis can be considered as an unrecognized independent risk factor for COVID-19 severity.

Serum adrenal androgens in hyperprolactinaemic women prior to, during, and after chronic treatment with bromocriptine

1982 ◽  
Vol 101 (2) ◽  
pp. 235-241 ◽  
Author(s):  
William S. Evans ◽  
Rick J. Schiebinger ◽  
Donald L. Kaiser ◽  
Wallace C. Nunley ◽  
D. Lynn Loriaux ◽  
...  
Keyword(s):  
Clinical Features ◽  
Polycystic Ovary ◽  
Serum Levels ◽  
Normal Range ◽  
Adrenal Androgen ◽  
Ovary Syndrome ◽  
Adrenal Androgens ◽  
Dopaminergic Drugs ◽  
The Mean ◽  
A Prospective Study

Abstract. Conflicting data exist in the literature regarding serum adrenal androgen concentrations in hyperprolactinaemic states and the influence or lack thereof of dopaminergic drugs on the androgens. We carried out a prospective study on 7 hyperprolactinaemic women, none of whom had clinical features commonly associated with elevated androgens. Serum levels of prolactin (Prl), cortisol, androstenedione, dehydroepiandrosterone (DHA) and dehydroepiandrosterone sulphate (DHAS) were measured basally, at 3, 6, and 12 months during chronic bromocriptine therapy, and 2 months following withdrawal of the drug. Prior to bromocriptine therapy, and despite a mean serum Prl of 178 ng/ml, all values of cortisol, androstenedione and DHA were normal as were 6 of 7 DHAS values. During treatment with bromocriptine for 12 months, the mean Prl level dropped into the normal range, but levels of cortisol, androstenedione and DHA remained unchanged. DHAS was significantly lower at 12 months when compared to initial levels but was not significantly different at 3 and 6 months. No significant differences were observed in cortisol or androgens 2 months after termination of the bromocriptine compared to basal levels. A significant correlation was observed between cortisol and both androstenedione (P = 0.0042) and DHA (P = 0.0002) but not with DHAS. A significant correlation was found to exist between Prl and DHAS (P < 0.0001) but not with androstenedione or DHA. Thus, we found normal levels of serum adrenal androgens in 6 of 7 hyperprolactinaemic women, none of whom demonstrated clinical features of the polycystic ovary syndrome. These data suggest: 1) increased basal adrenal androgens in hyperprolactinaemia may not be as common as previously reported; 2) androstenedione and DHA do not correlate with Prl; 3) DHAS is correlated with Prl. Although it appears that DHAS and prolactin concentrations are related, the mechanism underlying this relationship remains uncertain.

scholarly journals Catechol-O-methyltransferase genotype is associated with plasma total homocysteine levels and may increase venous thrombosis risk

2007 ◽  
Vol 98 (12) ◽  
pp. 1226-1231 ◽  
Author(s):  
Sita Vermeulen ◽  
Ad Hermus ◽  
Henk Blom ◽  
Henkjan Gellekink ◽  
Jan-Willem Muntjewerff ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Haplotype Analysis ◽  
Case Control Study ◽  
Primary Objective ◽  
Thrombosis Risk ◽  
Total Homocysteine ◽  
Recurrent Venous Thrombosis ◽  
Plasma Total Homocysteine ◽  
Control Study

SummaryA disturbed methylation has been proposed as a mechanism via which homocysteine is associated with diseases like vascular disease, neural tube defects and mental disorders. Catechol- O-methyltransferase (COMT) is involved in the S-adenosylmethionine- dependent methylation of catecholamines and catecholestrogens and in this way contributes to homocysteine synthesis. COMT dysfunction has been related to schizophrenia and breast cancer. We hypothesized that COMT dysfunction by virtue of functional genetic polymorphisms may affect plasma total homocysteine (tHcy). Our primary objective was to study the association between common COMT polymorphisms and tHcy. Secondly, we evaluated these polymorphisms as a risk factor for recurrent venous thrombosis. We obtained genotype data from four polymorphisms in the COMT gene (rs2097603, rs4633, rs4680 [324G>A] and rs174699) from 401 populationbased controls. We performed haplotype analysis to investigate the association between common haplotypes and tHcy. In addition, we assessed the rs4680 variant as a genetic risk factor in a case-control study on recurrent venous thrombosis (n= 169). We identified a common haplotype that was significantly associated with tHcy levels. This effect was largely explained by the rs4680 variant, resulting in an increase in tHcy of 10.4% (95% CI 0.01 to 0.21, p=0.03) for 324AA compared with 324GG subjects. Interestingly, we found that the 324AA genotype was more common in venous thrombosis patients (OR 1.61 [95% CI 0.97 to 2.65], p=0.06) compared to control subjects. We show that the COMT rs4680 variant modulates tHcy, and might be associated with venous thrombosis risk as well.

scholarly journals Increasing levels of free thyroxine as a risk factor for a first venous thrombosis: a case-control study

Blood ◽  
2010 ◽  
Vol 115 (22) ◽  
pp. 4344-4349 ◽  
Author(s):  
Bregje van Zaane ◽  
Alessandro Squizzato ◽  
Roeland Huijgen ◽  
Anton P. van Zanten ◽  
Eric Fliers ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Plasma Levels ◽  
Case Control Study ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Control ◽  
Free Thyroxine ◽  
Vein Thrombosis ◽  
Control Study

Abstract A hypercoagulable state exists in hyperthyroidism, but the association with venous thrombosis (VT) is not fully explored. We aimed to investigate VT risk for different plasma levels of thyroid hormones and thyroid antibodies. We used a case-control study on leg vein thrombosis conducted between September 1999 and August 2006 at the Academic Medical Center, Amsterdam, The Netherlands. Parameters of thyroid function were assessed in 190 cases (mean age, 57 years; range, 19-90 years) and 379 sex-matched controls (mean age, 56 years; range, 18-93 years). Odds ratios (ORs) and 95% confidence intervals (CIs) for VT risk were estimated according to several cutoff levels derived from plasma levels observed in controls. We found the risk of VT to gradually rise with increasing levels of free thyroxine (FT4). In the absence of traditional acquired risk factors, FT4 levels above 17 pmol/L yielded a sex- and age-adjusted OR of 2.2 (95% CI, 1.2-4.2) for deep VT, which further increased up to an OR of 13.0 (95% CI, 1.1-154.1) for FT4 levels above reference range. Our data suggest increasing levels of FT4 to be a risk factor for VT and may have implications for both the prevention and management of this disease.

ALCOHOL- AND TOBACCO CONSUMPTION IN PATIENTS WITH SUSPECTED DEEP VENOUS THROMBOSIS (DVT)

1987 ◽  
Author(s):  
C Lagerstedt ◽  
B Fagher ◽  
C G Olsson ◽  
B Ögvist
Keyword(s):  
Risk Factor ◽  
Alcohol Consumption ◽  
Prospective Study ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Significant Relationship ◽  
Tobacco Consumption ◽  
Ethanol Consumption ◽  
Middle Aged ◽  
A Prospective Study

Alcohol has several effects on hemostasis that might predispose for thromboembolism. The association between alcohol consumption and venous thrombosis is sparesly documented and we have therefore conducted a prospective study.Methods: 395 consecutive patients with suspected DVT entered the study. The patients were questioned about consumption of beer, wine and liquor and the average weekly consumption of ethanol was estimated. The total weekly consumption of tobacco was also estimated. 302 of the patients (130 men and 172 women) underwent phlebography, which was classified either as normal or as fresh DVT or/and postthrombotic changes.Results: 31 of the 130 men reported a weekly consumption of 100 g ethanol or more. In men below 65 years of age (62 men, see table) there was a significant relationship between ethanol consumption and the presence of fresh DVT or/and postthrombotic changes at phlebographyIn men above 65 years of age the incidence of DVT/postthrombotic changes was not higher among those who consumed more than 100 g ethanol per week (9 of 14) than among them who consumed less than 100 g per week (35 of 54). Only 5 of the women admitted a consumption of at least 100 g ethanol per week, one of them had a DVT.Tobacco consumption was not related to the occurrence of DVTConclusion: Ethanol seems to be a risk factor for DVT in young and middle-aged men

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