Thrombosis in Autoimmune Diseases: A Role for Immunosuppressive Treatments?

Silvestri, Elena; Scalera, Antonella; Emmi, Giacomo; Squatrito, Danilo; Ciucciarelli, Lucia; Cenci, Caterina; Tamburini, Carlo; Emmi, Lorenzo; Minno, Giovanni Di; Prisco, Domenico

doi:10.1055/s-0036-1579642

Cited by 22 publications

(8 citation statements)

References 146 publications

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“…An important argument in favor of the impact of inflammation in venous thromboembolism is the elevated risk of venous thrombosis and embolism in different inflammatory diseases, such as vasculitis, sarcoidosis, rheumatoid arthritis, inflammatory myopathies, gout, celiac and inflammatory bowel disease and perhaps other autoimmune diseases [5][6][7][8][9][10][11][12].…”

Section: Inflammation -The Connection Between Arterial and Venous Thrmentioning

confidence: 99%

“…Moreover, the metabolic syndrome -abdominal obesity, insulin resistance, arterial hypertension, hypertriglyceridemia, low HDL (high density lipoprotein) cholesterol -an important risk factor of the atherosclerotic disease, has been recently associated with venous thromboembolism [4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Inflammation -The Connection Between Arterial and Venous Thrmentioning

confidence: 99%

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Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Cocoi

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et al. 2017

Revista Romana De Medicina De Laborator

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Inflammation of the venous wall is involved in thrombogenesis, thrombus resolution, wall remodeling and the post-thrombotic syndrome. Different mechanisms are involved in both arterial and venous thrombosis and patients with atherothrombosis hold a higher risk of venous thrombosis. Although inflammation may represent the connection between arterial and venous thrombosis, it is not yet sure if it is the cause or consequence of venous thrombosis. Consequently, the relationships between inflammation markers as indicators of the inflammatory process and clinical venous thromboembolism need to be investigatd. For example, inflammation mediators such as the pro-inflammatory cytokines interleukin 8 (IL-8), IL-6, monocyte chemotactic protein 1 (MCP-1), C Reactive Protein (CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), matrix metalloproteinases and tumor necrosis factor alpha (TNF alpha)

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Section: Inflammation -The Connection Between Arterial and Venous Thrmentioning

confidence: 99%

Section: Inflammation -The Connection Between Arterial and Venous Thrmentioning

confidence: 99%

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Cocoi

Pop

Cocoi³

et al. 2017

Revista Romana De Medicina De Laborator

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“…Chronic inflammatory conditions, such as rheumatoid arthritis, are known to increase the risk of venous thromboembolism (VTE) . Several studies linked chronic inflammatory skin diseases (CISDs) with VTE in a range of data sources.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Venous Thromboembolism in Patients With Dermatologist-Diagnosed Chronic Inflammatory Skin Diseases

et al. 2021

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IMPORTANCE Several studies have linked chronic inflammatory skin diseases (CISDs) with venous thromboembolism (VTE) in a range of data sources with mixed conclusions. OBJECTIVE To examine the incidence of VTE in patients with vs without CISD. DESIGN, SETTING, AND PARTICIPANTSA cohort study using commercial insurance claims data from a nationwide US health care database from January 1, 2004, through 2019 was conducted. A total of 158 123 patients with dermatologist-recorded psoriasis, atopic dermatitis, alopecia areata, vitiligo, or hidradenitis suppurativa were included. Risk-set sampling identified patients without a CISD. Patient follow-up lasted until the first of the following occurred: VTE, death, disenrollment, or end of data stream. EXPOSURES Patients with vs without CISD.MAIN OUTCOMES AND MEASURES Venous thromboembolism events were identified with validated algorithms. Incidence rates were computed before and after 1:1 propensity-score matching to account for VTE risk factors. Hazard ratios were estimated to compare the incidence of VTE in the CISD vs non-CISD cohorts.RESULTS A total of 158 123 patients were identified with CISD: with psoriasis (n = 96 138), atopic dermatitis (n = 30 418), alopecia areata (n = 17 889), vitiligo (n = 7735), or HS (n = 5934); 9 patients had 2 of these conditions. A total of 1 570 387 patients were without a CISD. The median follow-up time was 1.9 years (interquartile range, 0.8-4.0 years) in patients with CISD. The incidence rate (per 1000 person-years) of outpatient or inpatient VTE was 1.57 in psoriasis, 1.83 in atopic dermatitis, 0.94 in alopecia areata, 0.93 in vitiligo, 1.65 in HS and 1.53 in CISD overall, compared with 1.76 in patients without a CISD. Incidence rates increased in patients aged 50 years or older (2.3 per 1000 person-years) and decreased in those aged 18 to 49 years (0.8 per 1000 person-years). After propensity-score matching to patients without a CISD, the hazard ratio (HR) of VTE was 0.86 (95% CI, 0.75-0.99) in psoriasis, 1.19 (95% CI, 0.95-1.48) in atopic dermatitis, 0.97 (95% CI, 0.65-1.46) in alopecia areata, 0.90 (95% CI, 0.49-1.65) in vitiligo, 1.64 (95% CI, 0.82-3.27) in hidradenitis suppurativa, and 0.94 (95% CI, 0.84-1.05) in CISD overall. CONCLUSIONS AND RELEVANCEIn this large-scale cohort study, CISDs were not associated with an increased incidence of VTE after controlling for relevant VTE risk factors in a representative dermatology patient population.

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“…However, given the rar ity of arte rial events due to can cer, supported by the lack of ben e fit even in patients with venous throm bo em bo lism, 43 it is unlikely to be ben e fi cial, and we there fore do not rec om mend it. Additional categories of sys temic dis or ders to con sider include auto im mune dis or ders (eg, rheu ma toid arthri tis, lupus, vas cu li tis) 44 and hema to logic dis or ders (eg, mye lo pro lif er a tive neo plasms, par ox ys mal noc tur nal hemoglobulinuria [PNH], sickle cell dis ease, plasma cell dis or ders, cryoglobulinemia), with pro posed eval u ation outlined in Figure 1. Emerging data indi cate infec tion with severe acute respira tory syn drome coronavirus 2 is asso ci ated with an increased throm botic risk, with reported occur rences in mul ti ple arte rial sites.…”

Section: Systemic Dis Easesmentioning

confidence: 99%

Unexplained arterial thrombosis: approach to diagnosis and treatment

May

Moll

2021

Hematology

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Arterial thrombotic events in younger patients without a readily apparent etiology present significant diagnostic and management challenges. We present a structured approach to diagnosis with consideration of common causes, including atherosclerosis and embolism, as well as uncommon causes, including medications and substances, vascular and anatomic abnormalities, systemic disorders, and thrombophilias. We highlight areas of management that have evolved within the past 5 years, including the use of dual-pathway inhibition in atherosclerotic disease, antithrombotic therapy selection in embolic stroke of undetermined source and left ventricular thrombus, the role of closure of patent foramen ovale for secondary stroke prevention, and the thrombotic potential of coronavirus disease 2019 infection and vaccination. We conclude with a representative case to illustrate the application of the diagnostic framework and discuss the importance of consideration of bleeding risk and patient preference in determining the appropriate management plan.

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Thrombosis in Autoimmune Diseases: A Role for Immunosuppressive Treatments?

Cited by 22 publications

References 146 publications

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

Incidence of Venous Thromboembolism in Patients With Dermatologist-Diagnosed Chronic Inflammatory Skin Diseases

Unexplained arterial thrombosis: approach to diagnosis and treatment

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