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      Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with aortic aneurysms: A nationwide cohort study

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          Abstract

          Studies on the association between aortic aneurysm (AA) and the subsequent risk of venous thromboembolism (VTE) are limited to a few case reports and investigations which only focused on surgical effects. Therefore, we used the National Health Insurance Research Database to clarify whether patients with AAs have a heightened risk of subsequent VTEs, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Our retrospective cohort study comprised patients aged ≥ 18 years who received a diagnosis of an AA and were hospitalized at any point during 2000–2010 (n = 16,630). Each AA patient was frequency-matched to 4 non-AA hospitalized patients based on age, sex, and index year (n = 66,453). The Cox proportional hazard regressions model was used to estimate the adjusted effect of AAs on VTE risk. The overall incidence of DVT and PE was higher in the patients with AA than in the non-AA group patients (23.5 versus 13.2 and 13.5 versus 7.98/1,000 person-years). After adjustment for age, sex, duration of hospitalization in the study period, and comorbidities, patients with AAs were associated with a 1.88-fold higher risk of DVT and 1.90-fold higher risk of PE compared to the non-AA cohort. Patients with abdominal AAs were more likely to develop DVT, whereas thoracic AA patients were more likely to develop PE. A diagnosis of a ruptured AA was associated with a substantially increased risk of DVT. Surgical treatment of AAs was associated with a heightened risk of VTE within 6-months post-operation. Our study demonstrates that AAs are associated with an increased risk of subsequent VTE. Future investigations are encouraged to delineate the mechanisms underlying this association and to evaluate the cost-effectiveness of screening for VTEs in patients with AAs.

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          Incidence and mortality of venous thrombosis: a population-based study.

          Estimates of the incidence of venous thrombosis (VT) vary, and data on mortality are limited. We estimated the incidence and mortality of a first VT event in a general population. From the residents of Nord-Trøndelag county in Norway aged 20 years and older (n = 94 194), we identified all cases with an objectively verified diagnosis of VT that occurred between 1995 and 2001. Patients and diagnosis characteristics were retrieved from medical records. Seven hundred and forty patients were identified with a first diagnosis of VT during 516,405 person-years of follow-up. The incidence rate for all first VT events was 1.43 per 1000 person-years [95% confidence interval (CI): 1.33-1.54], that for deep-vein thrombosis (DVT) was 0.93 per 1000 person-years (95% CI: 0.85-1.02), and that for pulmonary embolism (PE) was 0.50 per 1000 person-years (95% CI: 0.44-0.56). The incidence rates increased exponentially with age, and were slightly higher in women than in men. The 30-day case-fatality rate was higher in patients with PE than in those with DVT [9.7% vs. 4.6%, risk ratio 2.1 (95% CI: 1.2-3.7)]; it was also higher in patients with cancer than in patients without cancer [19.1% vs. 3.6%, risk ratio 3.8 (95% CI 1.6-9.2)]. The risk of dying was highest in the first months subsequent to the VT, after which it gradually approached the mortality rate in the general population. This study provides estimates of incidence and mortality of a first VT event in the general population.
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            The epidemiology of venous thromboembolism

            Venous thromboembolism (VTE) is categorized by the U.S. Surgeon General as a major public health problem. VTE is relatively common and associated with reduced survival and substantial health-care costs, and recurs frequently. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and VTE risk factors, including increasing patient age and obesity, hospitalization for surgery or acute illness, nursing-home confinement, active cancer, trauma or fracture, immobility or leg paresis, superficial vein thrombosis, and, in women, pregnancy and puerperium, oral contraception, and hormone therapy. Although independent VTE risk factors and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be relatively constant, or even increasing.
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              Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.

              The incidence of venous thromboembolism has not been well described, and there are no studies of long-term trends in the incidence of venous thromboembolism. To estimate the incidence of deep vein thrombosis and pulmonary embolism and to describe trends in incidence. We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990. The overall average age- and sex-adjusted annual incidence of venous thromboembolism was 117 per 100000 (deep vein thrombosis, 48 per 100000; pulmonary embolism, 69 per 100000), with higher age-adjusted rates among males than females (130 vs 110 per 100000, respectively). The incidence of venous thromboembolism rose markedly with increasing age for both sexes, with pulmonary embolism accounting for most of the increase. The incidence of pulmonary embolism was approximately 45% lower during the last 15 years of the study for both sexes and all age strata, while the incidence of deep vein thrombosis remained constant for males across all age strata, decreased for females younger than 55 years, and increased for women older than 60 years. Venous thromboembolism is a major national health problem, especially among the elderly. While the incidence of pulmonary embolism has decreased over time, the incidence of deep vein thrombosis remains unchanged for men and is increasing for older women. These findings emphasize the need for more accurate identification of patients at risk for venous thromboembolism, as well as a safe and effective prophylaxis.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 June 2017
                2017
                : 12
                : 6
                : e0178587
                Affiliations
                [1 ]Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
                [2 ]Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
                [3 ]Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
                [4 ]Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
                [5 ]College of Medicine, China Medical University, Taichung, Taiwan
                [6 ]Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
                [7 ]Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
                [8 ]Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
                [9 ]Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
                [10 ]Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
                Medical University Innsbruck, AUSTRIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: F-YL W-KC C-HK C-YL.

                • Data curation: C-LL F-YL.

                • Formal analysis: C-LL F-YL.

                • Funding acquisition: C-HK C-LL.

                • Investigation: F-YL W-KC C-HK C-YL.

                • Methodology: C-LL.

                • Resources: W-KC C-HK.

                • Software: C-LL.

                • Supervision: W-KC C-HK C-YL T-YY.

                • Validation: C-LL F-YL.

                • Visualization: C-LL.

                • Writing – original draft: F-YL C-HK C-YL T-YY.

                • Writing – review & editing: F-YL C-H Chiu C-H Chen T-YY.

                Author information
                http://orcid.org/0000-0002-3165-132X
                Article
                PONE-D-16-25643
                10.1371/journal.pone.0178587
                5462404
                28591152
                e2e607e6-4922-4b71-bdd5-864e41925bd2
                © 2017 Lee et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 27 June 2016
                : 6 May 2017
                Page count
                Figures: 1, Tables: 5, Pages: 14
                Funding
                Funded by: Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence
                Award ID: MOHW106-TDU-B-212-113004
                Funded by: China Medical University Hospital and Academia Sinica Taiwan Biobank Stroke Biosignature Project
                Award ID: BM10501010037
                Funded by: NRPB Stroke Clinical Trial Consortium
                Award ID: MOST 104-2325-B-039 -005
                Funded by: Tseng-Lien Lin Foundation, Taichung, Taiwan
                Funded by: Taiwan Brain Disease Foundation, Taipei, Taiwan
                Funded by: Katsuzo and Kiyo Aoshima Memorial Funds, Japan
                We thank the Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan for providing the service of statistical analysis. Miss Cheng-Li Lin have received her salary from Management Office for Health Data of China Medical University Hospital, Taichung, Taiwan and the department was supported from the list of funding. Dr. Tse-Yen Yang received the grant from China Medical University Hospital (DMR-106-162). This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004); China Medical University Hospital (DMR-106-162); Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037); NRPB Stroke Clinical Trial Consortium (MOST105-2325-B-039-003); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding has been received for this study.
                Categories
                Research Article
                Medicine and Health Sciences
                Vascular Medicine
                Thromboembolism
                Venous Thromboembolism
                Deep Vein Thrombosis
                Medicine and Health Sciences
                Vascular Medicine
                Vascular Diseases
                Aneurysms
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Surgical Oncology
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Oncology
                Surgical Oncology
                Medicine and Health Sciences
                Oncology
                Clinical Oncology
                Surgical Oncology
                Medicine and Health Sciences
                Vascular Medicine
                Thromboembolism
                Venous Thromboembolism
                Medicine and Health Sciences
                Cardiology
                Heart Failure
                Medicine and Health Sciences
                Cardiology
                Arrhythmia
                Atrial Fibrillation
                Custom metadata
                The data on the study population that were obtained from the NHIRD ( http://nhird.nhri.org.tw/en/index.html) are maintained in the NHIRD ( http://nhird.nhri.org.tw/).

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