Association Between Anemia and Cerebral Venous Thrombosis

Abstract

Background and Purpose— Anemia is often considered to be a risk factor for cerebral venous thrombosis (CVT), but this assumption is mostly based on case reports. We investigated the association between anemia and CVT in a controlled study. Methods— Unmatched case–control study: cases were adult patients with CVT included in a single-center, prospective database between July 2006 and December 2014. Controls were subjects from the control population of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) study. Anemia was defined according to World Health Organization criteria: nonpregnant women hemoglobin <7.5 mmol/L, pregnant women <6.9 mmol/L, and men <8.1 mmol/L. We used logistic regression analysis, adjusting for age, sex, malignancy, oral contraceptive use, and pregnancy/puerperium. Results— We included 152 cases and 2916 controls. Patients with CVT were younger (mean age, 40 versus 48 years) and more often women (74% versus 53%) than controls. Anemia was more frequent in cases (27.0%) than in controls (6.5%; P <0.001). Anemia was associated with CVT, both in univariate analysis (odds ratio, 5.3; 95% confidence interval [CI], 3.6–7.9) and after adjustment for potential confounders (adjusted odds ratio, 4.4; 95% CI, 2.8–6.9). Hemoglobin as a continuous variable was inversely associated with CVT (adjusted odds ratio per 1 mmol/L change 0.53; 95% CI, 0.42–0.66). Stratification by sex showed a stronger association between anemia and CVT in men (adjusted odds ratio, 9.9; 95% CI, 4.1–23.8) than in women (3.6; 95% CI, 2.1–6.0). Conclusion— Our data suggest that anemia is a risk factor for CVT.

Plasma hepcidin is associated with future risk of venous thromboembolism

“…19,20 Moreover, iron deficiency anemia has been associated with risk of incident VTE, 21 VTE recurrence, 22 PE, 23 and cerebral venous thrombosis. 24 However, iron deficiency anemia may have several causes, which may act as confounders for the association between iron deficiency and VTE. 25 Therefore, whereas the association between iron deficiency and high RDW as well as the association between high RDW and VTE risk seems well established, the association between iron deficiency and VTE remains to be proven.…”

The association between red cell distribution width and venous thromboembolism is not explained by myocardial infarction, stroke, or cancer

“…Previous studies have shown a strong association between RDW and iron deficiency anemia . Moreover, iron deficiency has recently been associated with increased risk of VTE recurrence, and anemia might be associated with risk of cerebral venous thrombosis . However, a recent case‐control study found no association between anemia and pulmonary embolism .…”

“…24,38 Moreover, iron deficiency has recently been associated with increased risk of VTE recurrence, 39 and anemia might be associated with risk of cerebral venous thrombosis. 40 However, a recent case-control study found no association between anemia and pulmonary embolism. 41 Moreover, the proportion of women with anemia was reported to be considerably higher in those of premenopausal age than in those of postmenopausal age in our cohort.…”

Thromboembolic adverse event study of combined estrogen-progestin preparations using Japanese Adverse Drug Event Report database

“…Recently, an association between anemia and cerebral venous thrombosis was reported [49]. Therefore, anemia patients should be monitored carefully.…”