Access Rate to the Emergency Department for Venous Thromboembolism in Relationship with Coarse and Fine Particulate Matter Air Pollution

Abstract

Particulate matter (PM) air pollution has been associated with cardiovascular and respiratory disease. Recent studies have proposed also a link with venous thromboembolism (VTE) risk. This study was aimed to evaluate the possible influence of air pollution-related changes on the daily flux of patients referring to the Emergency Department (ED) for VTE, dissecting the different effects of coarse and fine PM. From July 1st, 2007, to June 30th, 2009, data about ED accesses for VTE and about daily concentrations of PM air pollution in Verona district (Italy) were collected. Coarse PM (PM10-2.5) was calculated by subtracting the finest PM2.5 from the whole PM10. During the index period a total of 302 accesses for VTE were observed (135 males and 167 females; mean age 68.3±16.7 years). In multiple regression models adjusted for other atmospheric parameters PM10-2.5, but not PM2.5, concentrations were positively correlated with VTE (beta-coefficient = 0.237; P = 0.020). During the days with high levels of PM10-2.5 (≥75th percentile) there was an increased risk of ED accesses for VTE (OR 1.69 with 95%CI 1.13–2.53). By analysing days of exposure using distributed lag non-linear models, the increase of VTE risk was limited to PM10-2.5 peaks in the short-term period. Consistently with these results, in another cohort of subjects without active thrombosis (n = 102) an inverse correlation between PM10-2.5 and prothrombin time was found (R = −0.247; P = 0.012). Our results suggest that short-time exposure to high concentrations of PM10-2.5 may favour an increased rate of ED accesses for VTE through the induction of a prothrombotic state.

Venous Thromboembolism in an Industrial North American City: Temporal Distribution and Association with Particulate Matter Air Pollution

“…In fact, many EPA monitoring sites no longer measure PM 10 . Although all types of PM can activate inflammation, produce oxidative stress, and promote thrombosis and coagulation [1], [38], something specific to larger particles may be important in VTE as suggested by Martinelli et al [36]. Although our results could be interpreted as support for a significant role of larger particles, we cannot rule out the possibility that some specific component of PM 2.5 is important (even though the overall PM 2.5 peak occurred in the winter).…”

“…We attempted to minimize the effect of variable delay by grouping VTE cases per week (the mode of the delay distribution). Nevertheless, a study of VTE (302 cases over two years) in Verona, Italy found a correlation between daily coarse particle levels and the daily number of VTE cases [36]. Incorporation of lag-times into this analysis failed to show a correlation with VTE.…”

The Cardiopulmonary Effects of Ambient Air Pollution and Mechanistic Pathways: A Comparative Hierarchical Pathway Analysis

“…Further, the role of air pollution on venous thromboembolism (VTE) remains inconsistent, with some studies indicating an increased risk among those who had higher air pollution exposure [29] , [30] . However recent prospective studies do not support this association [31] , [32] .…”

Indoor air pollution

“…Studies have determined a positive correlation between PM 2.5 levels and respiratory tract disease prevalence, hospitalization rates, and daily death rates [16,17]. These relations are more marked in the elderly, pregnant women, babies, adolescents, subjects with a history of cardiopulmonary disease and other susceptible populations [18][19][20]. One study of a seven-year period in the USA (from 2000 to 2007) showed that every 10 µg / m 3 decrease in PM 2.5 extended life spans by 0.35 years [21].…”