Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census

Stein, Paul D.; Kayali, Fadi; Olson, R. E.; Milford, Creagh E.

doi:10.1016/j.amjmed.2003.11.020

Cited by 189 publications

(137 citation statements)

References 37 publications

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“…However, Chinese patients had a significantly lower risk of venous thrombosis as compared with Caucasian patients, even after adjustment for other factors in the full multivariate model. This is consistent with the clinical observation that Chinese and Asian patients generally have a lower incidence of deep vein thrombosis and pulmonary embolism compared with Caucasian patients (41,42). While the lower prevalence of aPL and the less frequent use of exogenous hormones might contribute to the lower incidence of venous thrombosis observed in our Chinese patients, other factors not addressed in this study may be responsible for this ethnic difference.…”

Section: Discussionsupporting

confidence: 79%

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Mok

Tang

et al. 2005

Arthritis & Rheumatism

220

173

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Objective. To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds.Methods. SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins.Results. We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean ؎ SD age at SLE diagnosis was 35.7 ؎ 14 years. After a followup of 3,094 patientyears, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P ‫؍‬ 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events.Conclusion. There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.Premature atherosclerosis is a major cause of mortality and late morbidity in patients with systemic lupus erythematosus (SLE) (1-3). In several cohort studies, it was found that atherosclerotic cardiovascular and cerebrovascular diseases are more common causes of late deaths than active SLE itself (1,(4)(5)(6). More recent studies have demonstrated that subclinical coronary heart disease and carotid plaque were present in a significantly higher proportion of SLE patients than in age-and sex-matched control subjects with similar risk factors (7,8). The etiology of accelerated atherosclerosis in SLE is multifactorial and cannot be fully explained by traditional risk factors (9).Compared with individuals without SLE, the risk of myocardial infarction in SLE patients is 2-50 times higher, and the risk of stroke is 2-10 times higher (2,9,10). The prevalence of symptomatic coronary heart disease in SLE patients has been reported to be 6-20%, The Hopkins Lupus Cohort is supported by NIH grants R01-AR-43727 and M01-RR-00052 (to the outpatient Clinical Research Center).

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Section: Discussionsupporting

confidence: 79%

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Mok

Tang

et al. 2005

Arthritis & Rheumatism

220

173

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“…High rates of thrombus resolution have also been reported from Taiwan for calf DVT after total knee arthroplasty [30]. Interestingly, and in common with Asians living in Asian countries, community surveys find that Asians living in the US appear to have relatively low rates of symptomatic thromboembolism than Americans of European origin, suggesting that genetic and cultural traits may contribute to thrombosis [31]. Clinical manifestation of DVT may, therefore, be less frequent in Asian than in Western patients.…”

Section: Postsurgical Deep-vein Thrombosis In Asia 2667mentioning

confidence: 92%

Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography

Piovella

Wang

Lü

et al. 2005

Journal of Thrombosis and Haemostasis

186

157

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Summary. Background: The incidence of postsurgical venous thromboembolism is thought to be low in Asian ethnic populations. Objective: We studied the incidence of deep‐vein thrombosis (DVT) in Asian patients undergoing major orthopedic surgery of the lower limbs. Patients/methods: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, South Korea, Malaysia, Philippines, Taiwan, and Thailand) in patients undergoing elective total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) without pharmacological thromboprophylaxis. The primary endpoint was the rate of DVT of the lower limbs documented objectively with bilateral ascending venography performed 6–10 days after surgery using a standardized technique and evaluated by a central adjudication committee unaware of local interpretation. Results: Overall, of 837 Asian patients screened for this survey, 407 (48.6%, aged 20–99 years) undergoing THR (n = 175), TKR (n = 136) or HFS (n = 96) were recruited in 19 centers. DVT was diagnosed in 121 of 295 evaluable patients [41.0%, (95% confidence interval (CI): 35.4–46.7)]. Proximal DVT was found in 30 patients [10.2% (7.0–14.2)]. Total DVT and proximal DVT rates were highest in TKR patients (58.1% and 17.1%, respectively), followed by HFS patients (42.0% and 7.2%, respectively), then THR patients (25.6% and 5.8%, respectively). DVT was more frequent in female patients aged at least 65 years. Pulmonary embolism was clinically suspected in 10 of 407 patients (2.5%) and objectively confirmed in two (0.5%). Conclusions: The rate of venographic thrombosis in the absence of thromboprophylaxis after major joint surgery in Asian patients is similar to that previously reported in patients in Western countries.

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“…This situation necessitates the generation of several appropriate age-dependent reference ranges to interpret laboratory data in pediatric patients and prevent misclassification of children having defects of factors and inhibitors of the coagulation system (7). Since there are differences in the hemostatic system among different racial/ethnic groups (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and also between different analyzer and reagent systems (4), coagulation laboratories should develop age-related reference ranges specific to their own testing systems for the local population (4,7,32). In this study, we analyzed retrospectively the results of preoperative APTT testing in childhood and adult controls undergoing minor elective surgery.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the incidence and risk of venous thromboembolism (VTE) is markedly lower in Asian/Pacific Islanders than in Caucasians and African Americans (10)(11)(12)(13)(14). VTE is not as common in Chinese as in Caucasians (15).…”

Section: Introductionmentioning

confidence: 99%

Age-associated developmental changes in the activated partial thromboplastin time (APTT) and causes of prolonged APTT values in healthy Chinese children

Lai

Yan

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census

Cited by 189 publications

References 37 publications

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups

Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography

Age-associated developmental changes in the activated partial thromboplastin time (APTT) and causes of prolonged APTT values in healthy Chinese children

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