The risk and trend of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a general population-based study

Li, Lingyi; Lu, Na; Avina-Galindo, Ana Michelle; Zheng, Yan; Lacaille, Diane; Esdaile, John M.; Choi, Hyon K.; Aviña‐Zubieta, J Antonio

doi:10.1093/rheumatology/keaa262

Cited by 39 publications

(37 citation statements)

References 34 publications

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“…As already mentioned, in clinical practice, an increased incidence of VTE has been described in patients with inflammatory diseases such as asthma, [37][38][39] chronic obstructive pulmonary disease, [40][41][42][43] inflammatory bowel diseases, [44][45][46] arthritis, [47][48][49] and other autoimmune diseases. [50][51][52][53] The risk of VTE is particularly enhanced during their exacerbations, which are usually treated with exogenous glucocorticoids.…”

Section: Molecular Effects Of Exogenous Hypercortisolism On Hemostasismentioning

confidence: 99%

Use of Glucocorticoids and Risk of Venous Thromboembolism: A Narrative Review

Simion

Campello

Bensi

et al. 2021

Semin Thromb Hemost

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Glucocorticoids are potent anti-inflammatory agents that are widely used for the treatment of many inflammatory, autoimmune, and neoplastic disorders. However, their beneficial effect is associated with several side effects, including an increased risk of cardiovascular complications, such as myocardial infarction and stroke. Whether their use also contributes to a procoagulant state, and therefore increases the risk of venous thromboembolism (VTE), is still a matter of debate. As an increased risk of venous thrombotic events is described in patients with Cushing's syndrome, which is characterized by endogenous hypercortisolism, it is reasonable to speculate that the chronic administration of glucocorticoids may induce a hypercoagulable state. However, it seems virtually impossible to separate the role of the drug from the underlying condition, which itself predisposes to the development of VTE. Actually, some evidence suggests that the use of exogenous glucocorticoids for the treatment of underlying disease and its exacerbations may further amplify the risk of VTE. Moreover, a procoagulant state has also been reported in healthy participants receiving oral glucocorticoids versus placebo. We have performed a concise narrative review on available data on the influence of exogenous glucocorticoids on hemostasis and their clinical impact on the risk of VTE.

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Section: Molecular Effects Of Exogenous Hypercortisolism On Hemostasismentioning

confidence: 99%

Use of Glucocorticoids and Risk of Venous Thromboembolism: A Narrative Review

Simion

Campello

Bensi

et al. 2021

Semin Thromb Hemost

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“…Unmeasured confounding is another major concern. For example, certain auto-immune conditions such as rheumatoid arteritis are associated with hypertension [ 51 ], and with the risk of VTE [ 52 ]. Assuming that these types of conditions can cause hypertension, then associations between hypertension and VTE may be positively biased, which could potentially explain the observations between hypertension and PA.…”

Section: Discussionmentioning

confidence: 99%

Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women

et al. 2021

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Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism.

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“…In several studies, the VTE risk was stable over follow-up time [ 36 , 39 ]. In other studies, the VTE risk was highest during the first year, then attenuated with time but remained statistically elevated even 5 years after RA diagnosis [ 42 , 46 ]. Among hospitalized RA patients, the PE risk was highest during the first year after hospitalization.…”

Section: Vte Risks In Ra Patientsmentioning

confidence: 95%

Risk of venous thromboembolism associated with Janus kinase inhibitors for rheumatoid arthritis: case presentation and literature review

2021

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Janus kinase (JAK) inhibitors have been developed as disease-modifying antirheumatic drugs. Despite the positive therapeutic impacts of JAK inhibitors, concerns have been raised regarding the risk of venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE). A recent post hoc safety analysis of placebo-controlled trials of JAK inhibitors in rheumatoid arthritis (RA) reported an imbalance in the incidence of VTE for a 4-mg daily dose of baricitinib versus placebo. In a recent postmarketing surveillance trial for RA, a significantly higher incidence of PE was reported in treatment with tofacitinib (10 mg twice daily) compared with tofacitinib 5 mg or tumor necrosis factor inhibitors. We also experienced a case of massive PE occurring 3 months after starting baricitinib (4 mg once daily) for multiple biologic-resistant RA. Nevertheless, the evidence to support the role of JAK inhibitors in VTE risk remains insufficient. There are a number of predisposing conditions and risk factors for VTE. In addition to the known risk factors that can provoke VTE, advanced age, obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking can also contribute to its development. Greater VTE risk is noted in patients with chronic inflammatory conditions, particularly RA patients with uncontrolled disease activity and any comorbidity. Prior to the initiation of JAK inhibitors, clinicians should consider both the number and strength of VTE risk factors for each patient. In addition, clinicians should advise patients to seek prompt medical help if they develop clinical signs and symptoms that suggest VTE/PE. Key Points• Patients with rheumatoid arthritis (RA) are at increased risk of venous thromboembolism (VTE), especially those with uncontrolled, high disease activity and those with comorbidities.• In addition to the well-known risk factors that provoke VTE events, advanced age and cardiovascular risk factors, such as obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking, should be considered risk factors for VTE.• Although a signal of VTE/pulmonary embolism (PE) risk with JAK inhibitors has been noted in RA patients who are already at high risk, the evidence is currently insufficient to support the increased risk of VTE during RA treatment with JAK inhibitors.• If there are no suitable alternatives, clinicians should prescribe JAK inhibitors with caution, considering both the strength of individual risk factors and the cumulative weight of all risk factors for each patient.

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The risk and trend of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a general population-based study

Cited by 39 publications

References 34 publications

Use of Glucocorticoids and Risk of Venous Thromboembolism: A Narrative Review

Use of Glucocorticoids and Risk of Venous Thromboembolism: A Narrative Review

Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women

Risk of venous thromboembolism associated with Janus kinase inhibitors for rheumatoid arthritis: case presentation and literature review

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