Dataset Information

Acute infection as a trigger for incident venous thromboembolism: Results from a population-based case-crossover study.

ABSTRACT:

Background

A bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE-risk is explained by immobilization is unknown.

Aims

To investigate the impact of hospitalization with acute infection on the VTE-risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory- (RTI) and urinary- (UTI) tract infections on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Methods

We conducted a case-crossover study of VTE-patients (n = 707) recruited from a general population. Hospitalizations and VTE-triggers were registered during the 90 days before a VTE (hazard period) and in four preceding 90-day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) for VTE according to triggers.

Results

Acute infection was registered in 267 (37.8%) of the hazard periods and in 107 (3.8%) of the control periods, corresponding to a high VTE-risk after infection (OR 24.2, 95% CI 17.2-34.0), that was attenuated to 15-fold increased after adjustment for immobilization. The risk was 20-fold increased after infection without concomitant immobilization, 73-fold increased after immobilization without infection, and 141-fold increased with the two combined. The risk of PE was apparently higher after RTIs (OR 48.3, 95% CI 19.4-120.0) than UTIs (OR 12.6, 95% CI 6.4-24.7), but diminished in sensitivity analyses excluding uncertain RTI diagnoses.

Conclusions

Our findings suggest that hospitalization with infection is a strong VTE-trigger also in non-immobilized patients. Infection and immobilization had a synergistic effect on the VTE-risk.

SUBMITTER: Grimnes G

PROVIDER: S-EPMC6055491 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Publications

Acute infection as a trigger for incident venous thromboembolism: Results from a population-based case-crossover study.

Grimnes Gro G Isaksen Trond T Tichelaar Y I G Vladimir YIGV Brækkan Sigrid K SK Hansen John-Bjarne JB

Research and practice in thrombosis and haemostasis 20171221 1

<h4>Background</h4>A bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE-risk is explained by immobilization is unknown.<h4>Aims</h4>To investigate the impact of hospitalization with acute infection on the VTE-risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory- (RTI) and urinary- (UTI) tract infecti ...[more]

PMID: 30046710

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Project description:ImportanceThe risk of venous thromboembolism (VTE) in ambulatory COVID-19 is controversial. In addition, the association of vaccination with COVID-19-related VTE and relevant clinical and genetic risk factors remain to be elucidated.ObjectiveTo quantify the association between ambulatory COVID-19 and short-term risk of VTE, study the potential protective role of vaccination, and investigate clinical and genetic risk factors for post-COVID-19 VTE.Design, setting, and participantsThis population-based cohort study of patients with COVID-19 from UK Biobank included participants with SARS-CoV-2 infection that was confirmed by a positive polymerase chain test reaction result between March 1, 2020, and September 3, 2021, who were then propensity score matched to COVID-19-naive people during the same period. Participants with a history of VTE who used antithrombotic drugs (1 year before index dates) or tested positive in hospital were excluded.ExposuresFirst infection with SARS-CoV-2, age, sex, ethnicity, socioeconomic status, obesity, vaccination status, and inherited thrombophilia.Main outcomes and measuresThe primary outcome was a composite VTE, including deep vein thrombosis or pulmonary embolism, which occurred 30 days after the infection. Hazard ratios (HRs) with 95% CIs were calculated using cause-specific Cox models.ResultsIn 18 818 outpatients with COVID-19 (10 580 women [56.2%]; mean [SD] age, 64.3 [8.0] years) and 93 179 matched uninfected participants (52 177 women [56.0%]; mean [SD] age, 64.3 [7.9] years), the infection was associated with an increased risk of VTE in 30 days (incidence rate of 50.99 and 2.37 per 1000 person-years for infected and uninfected people, respectively; HR, 21.42; 95% CI, 12.63-36.31). However, risk was substantially attenuated among the fully vaccinated (HR, 5.95; 95% CI, 1.82-19.5; interaction P = .02). In patients with COVID-19, older age, male sex, and obesity were independently associated with higher risk, with adjusted HRs of 1.87 (95% CI, 1.50-2.33) per 10 years, 1.69 (95% CI, 1.30-2.19), and 1.83 (95% CI, 1.28-2.61), respectively. Further, inherited thrombophilia was associated with an HR of 2.05 (95% CI, 1.15-3.66) for post-COVID-19 VTE.Conclusions and relevanceIn this population-based cohort study of patients with COVID-19, ambulatory COVID-19 was associated with a substantially increased risk of incident VTE, but this risk was greatly reduced in fully vaccinated people with breakthrough infection. Older age, male sex, and obesity were clinical risk factors for post-COVID-19 VTE; factor V Leiden thrombophilia was additionally associated with double the risk, comparable with the risk of 10-year aging. These findings may reinforce the need for vaccination, inform VTE risk stratification, and call for targeted VTE prophylaxis strategies for unvaccinated outpatients with COVID-19.

Project description:BACKGROUND:Heart failure (HF) hospitalization places patients at increased short-term risk for venous thromboembolism (VTE). Long-term risk for VTE associated with incident HF, HF subtypes, or structural heart disease is unknown. OBJECTIVES:In the ARIC (Atherosclerosis Risk In Communities) cohort, VTE risk associated with incident HF, HF subtypes, and abnormal echocardiographic measures in the absence of clinical HF was assessed. METHODS:During follow-up, ARIC identified incident HF and subcategorized HF with preserved ejection fraction or reduced ejection fraction. At the fifth clinical examination, echocardiography was performed. Physicians adjudicated incident VTE using hospital records. Adjusted Cox proportional hazards models were used to evaluate the association between HF or echocardiographic exposures and VTE. RESULTS:Over a mean of 22 years in 13,728 subjects, of whom 2,696 (20%) developed incident HF, 729 subsequent VTE events were identified. HF was associated with increased long-term risk for VTE (adjusted hazard ratio: 3.13; 95% confidence interval: 2.58 to 3.80). In 7,588 subjects followed for a mean of 10 years, the risk for VTE was similar for HF with preserved ejection fraction (adjusted hazard ratio: 4.71; 95% CI: 2.94 to 7.52) and HF with reduced ejection fraction (adjusted hazard ratio: 5.53; 95% confidence interval: 3.42 to 8.94). In 5,438 subjects without HF followed for a mean of 3.5 years, left ventricular relative wall thickness and mean left ventricular wall thickness were independent predictors of VTE. CONCLUSIONS:In this prospective population-based study, incident hospitalized HF (including both heart failure with preserved ejection fraction and reduced ejection fraction), as well as echocardiographic indicators of left ventricular remodeling, were associated with greatly increased risk for VTE, which persisted through long-term follow-up. Evidence-based strategies to prevent long-term VTE in patients with HF, beyond time of hospitalization, are needed.

Dataset Information

Acute infection as a trigger for incident venous thromboembolism: Results from a population-based case-crossover study.

Background

Aims

Methods

Results

Conclusions

Publications

Acute infection as a trigger for incident venous thromboembolism: Results from a population-based case-crossover study.

Similar Datasets

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