Low Vitamin D Levels Are Associated With the Development of Deep Venous Thromboembolic Events in Patients With Ischemic Stroke

Abstract

The objective is to determine whether a low serum 25-hydroxyvitamin D (25(OH)D) level is associated with an increased incidence of deep venous thromboembolic events in patients with ischemic stroke. One hundred eighty persons admitted consecutively for inpatient rehabilitation at the Department of Rehabilitation of the First Affiliated Hospital of Wenzhou Medical University with a diagnosis of ischemic stroke from January 2015 to December 2015 were enrolled. The following demographic data were collected: age, sex, body mass index, and history of risk factors. The levels of 25(OH)D and the presence of deep vein thrombosis (DVT) by routine duplex imaging were also recorded. The value of 25(OH)D needed to predict DVT was analyzed using logistic regression analysis, after adjusting for the possible confounders. We found that 80% of patients admitted to the acute inpatient rehabilitation unit had low levels of vitamin D. Forty-seven patients had DVT, and the incidence of DVT was 26.1% within 3 weeks after the stroke event. With all patients taken together, DVT occurrence as a dependent variable with the sufficient group as the reference used for vitamin D levels in the logistic analysis, deficiency of vitamin D was independently associated with the development of DVT (odds ratio = 4.683, 95% confidence interval: 1.396-15.703, P = .012). In conclusion, low serum 25(OH)D levels were independent predictors of DVT in patients with ischemic stroke during inpatient rehabilitation stay in China. This finding reveals the critical role played by 25(OH)D in the pathogenesis of DVT.

MECHANISMS IN ENDOCRINOLOGY: Vitamin D and COVID-19

“…Other studies have suggested that 1,25 (OH) 2 D can downregulate proinflammatory signaling and promote inhibition of tissue factor activity, thus reducing a prothrombotic milieu (125). In addition, a limited number of clinical reports, antedating the COVID-19 era suggest a link between the development of vitamin D deficiency and incident thrombotic events, including deep venous thrombosis and cerebrovascular events (126,127,128). This may be especially true in patients who are critically ill and require intensive care, among whom low 25-OHD levels have been reported in up to 80% in the pre-COVID-19 era (129,130).…”

Vitamin D receptor stimulation to reduce acute respiratory distress syndrome (ARDS) in patients with coronavirus SARS-CoV-2 infections

“…This was accompanied by the up-regulation of TF signaling mediator protease-activated receptor 2 (PAR-2) [70]. Observational data in humans revealed an association between low levels of 25OHD and the development of deep venous thromboembolic (DVT) [71] events in patients with ischemic stroke. Conversely, a significant positive association was found between serum levels 25OHD (> 20 ng/mL) and TF pathway inhibitor (TFPI) [a dual inhibitor of coagulation by binding to both TF/Factor VIIa complex as well as Factor Xa] [72].Most intervention studies however did not show clear benefits of vitamin D supplementation on major cardiovascular events, although most study subjects were not severely vitamin D deficient at baseline [3].…”

Emerging Role of Vitamin D and its Associated Molecules in Pathways Related to Pathogenesis of Thrombosis

“…While the anti-thrombogenic components are antithrombin, plasminogen, tissue plasminogen activator, heparin, thrombomodulin, and protein C and S [53]. The anti-thrombotic effects of vitamin D on these thrombogenic and anti-thrombogenic components of the coagulation system have been very well documented [51,54,55]. A recent study demonstrated the association of low vitamin D levels with the development of deep venous thromboembolic (DVT) events in patients with ischemic stroke [51].…”

“…The anti-thrombotic effects of vitamin D on these thrombogenic and anti-thrombogenic components of the coagulation system have been very well documented [51,54,55]. A recent study demonstrated the association of low vitamin D levels with the development of deep venous thromboembolic (DVT) events in patients with ischemic stroke [51]. Likewise, a case-control study observed that the concentration of 25(OH)D was significantly lower in 82 participants with idiopathic lower-extremity DVT as compared to 85 sex and age-matched healthy participants [50].…”

“…Plasma levels of vitamin D metabolites and its associated molecules are one of them that have appeared to be an intriguing factor involved in regulatory processes related to thrombosis [49]. There are shreds of evidence from the clinical reports that have correlated deficiency of vitamin D with the increase in thrombotic episodes [50,51]. Besides, Vitamin D, directly or indirectly, controls the expression of more than 200 genes, such as epidermal growth factor receptor, phospholipase C, gamma 1, Insulin growth factor binding protein 3, and many more, that are responsible for the regulation of cellular proliferation, differentiation, apoptosis, and angiogenesis [52].…”