C-reactive protein and risk of venous thromboembolism: results from a population-based case-crossover study

Abstract

Long-term, low-grade inflammation does not seem to be a risk factor for venous thromboembolism. The impact of acute inflammation, regardless of cause, on risk of venous thromboembolism is scarcely studied. We aimed to investigate the impact of acute inflammation, assessed by C-reactive protein, on short-term risk of venous thromboembolism. We conducted a case-crossover study of patients with venous thromboembolism (n=707) recruited from a general population. Information on triggers and C-reactive protein levels were retrieved from hospital records during the 90 days before the event (hazard period) and in four preceding 90-day control periods. Conditional logistic regression was used to obtain β coefficients for change in natural log (ln) transformed C-reactive protein from control to hazard periods and to determine corresponding odds ratios for venous thromboembolism. Median C-reactive protein was 107 mg/L in the hazard period, and ranged from 7 mg/L to 16 mg/L in the control periods. The level of C-reactive protein was 58% (95% CI 39-77%) higher in the hazard period than in the control periods. A one-unit increase in ln-C-reactive protein was associated with increased risk of venous thromboembolism (OR 1.79, 95% CI 1.48-2.16). The risk estimates were only slightly attenuated after adjustment for immobilization and infection. In stratified analyses, ln-C-reactive protein was associated with increased risk of venous thromboembolism in cases with (OR 1.55, 95% CI 1.01-2.38) and without infection (OR 1.77, 95% CI 1.22-2.57). In conclusion, we found that acute inflammation, assessed by C-reactive protein, was a trigger for venous thromboembolism.

COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection

“…Inflammatory markers, including CRP and ESR, were also associated with thrombosis ( Figure 2 ), and elevations in several coagulation and inflammatory markers were associated with critical illness and mortality ( Figures 4 - 5 ), albeit with a high degree of uncertainty in the mortality models, as manifested by very wide confidence intervals. Acute inflammation, as measured by elevations in these markers, has previously been associated with increased thrombotic and bleeding risk in patients without COVID-19 19 , 20 ; indeed, we found significant correlations between D-dimer levels and each measured inflammatory marker ( Figure 1 ). Given previously reported 14-day cumulative VTE rates of 7% to 8% in critically ill patients without COVID-19 receiving standard heparin-based thromboprophylaxis, 21 our observed rate of 7.6% in critically ill patients receiving similar prophylactic treatment over a median follow-up of 10 days was comparable.…”

“…Coronavirus disease 2019 (COVID- 19), first identified in Wuhan, China in December of 2019, has become a worldwide pandemic with widespread illness and mortality and a profound impact on society, culture, and the global economy. Although respiratory compromise is the cardinal feature of the disease, early studies have suggested that elevated circulating D-dimer levels are associated with mortality, 1,2 suggesting a distinct coagulation disorder associated with COVID-19.…”

Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

“…67.66% (385/569) of the patients were transferred to our hospital from other hospitals due to serious illness or limited medical conditions.Preoperative preparation for patients with medical diseases and routine preoperative examinations such as DVT screening will also delay surgery.Recently, Luksameearunothai et al con rmed that Caprini score ≥ 12 points should be used for preoperative ultrasound examination in elderly patients with hip fracture and patients with Wells score ≤ 1 points can be safely operated immediately [19] .There is a con ict between adequate preoperative preparation and early surgery and how to achieve a comprehensive and scienti c evaluation of severe patients is the key to avoid unnecessary delay in surgery. Brill and Parvizi reported that chronic pulmonary disease is associated with postoperative DVT in patients with fracture [20,21] .We further found that COPD was an independent risk factor for preoperative DVT and pulmonary infection, and COPD was an independent risk factor for postoperative DVT.Systemic in ammation, hypoxemia, oxidative stress, endothelial dysfunction, and prethrombotic status would increase the risk of VTE in patients with COPD [22] .Elderly fracture patients with COPD may be chronically hypoxic for a long time.Lying in bed and immobilization after a fracture would increase the risk of pulmonary infection, as well as limited mobility and lack of muscle pumping, leading to venous stasis and hypercoagulability in the lower extremities [23] .Therefore, active prevention and treatment of pulmonary diseases in patients with fractures may reduce the incidence of perioperative DVT.The European Guidelines for the prevention of perioperative VTE indicate that correcting preoperative anemia could reduce the incidence of postoperative VTE in elderly patients [24] .Both we and Feng found that preoperative anemia was an independent risk factor for perioperative DVT in fracture patients, which may be associated with increased D-dimer caused by anemia [26] .C-reactive protein levels on the rst and third days after surgery were independent risk factors for postoperative DVT, and acute in ammation re ected by high levels of C-reactive protein was considered as the trigger factor for VTE [27] .The timing and necessity of perioperative anti-infective therapy need to be further validated.Hypoproteinemia is another independent risk factor for DVT. It may be that the swelling of the lower extremities leads to weakened muscle pumping and slow blood ow, and the pain caused by swelling also reduces the active activity of the lower extremities.Many studies have con rmed that hypertension, hyperlipidemia, diabetes and other chronic diseases were risk factors for DVT.…”

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

“…Since exposure to potassium supplements, NSAIDs, and antibiotics is considered to be a transient effect, each patient can be "exposed" and "not exposed" at different time periods. For each patient, exposure in the "hazard" period immediately preceding the outcome was compared with exposure in "control" period(s) earlier in time [29,31]. The main study design is displayed in Fig.…”