Venous thromboembolism discharge diagnoses in the Danish National Patient Registry should be used with caution

Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim; Dethlefsen, Claus; Tjønneland, Anne

doi:10.1016/j.jclinepi.2009.03.018

Cited by 189 publications

(191 citation statements)

References 19 publications

(13 reference statements)

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“…Our method of endpoint diagnoses was, however, validated in 2010 with a positive predicted value of 59% for venous thromboembolism diagnosed in any setting and 75% for venous thromboembolism diagnosed during hospital admission (17 ). However, misclassification of venous thromboembolism is likely to be nondifferential, thereby leading only to bias to- ward the null hypothesis, and therefore cannot explain the present findings.…”

Section: Discussionmentioning

confidence: 72%

“…These diagnoses with identical ICD-8 and ICD-10 codes were also identified in the national Danish Causes of Death registry from 1977 through April 2013. This approach has been used previously (8,9,16 ) and was validated in 2010 with a positive predictive value of 59% for venous thromboembolism diagnosed in any setting and 75% for venous thromboembolism diagnosed during hospital admission (17 ). Information on death and emigration were obtained from the Danish Civil Registration System.…”

Section: Venous Thromboembolism (Deep Venous Thrombosis and Pulmonarymentioning

confidence: 99%

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Complement C3 and High Risk of Venous Thromboembolism: 80517 Individuals from the Copenhagen General Population Study

2016

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BACKGROUND Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS We included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003–2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals were lost to follow-up. RESULTS Complement C3 concentrations were approximately normally distributed, with a mean value of 1.13 g/L (interquartile range 0.98–1.26; SD 0.21). The cumulative incidence of venous thromboembolism was higher with progressively higher tertiles of complement C3 (log-rank trend: P = 3 × 10−8): at age 80, 7%, 9%, and 11% of individuals in the first, second, and third tertiles, respectively, had developed venous thromboembolism. Multivariable-adjusted hazard ratios for venous thromboembolism compared with individuals in the first tertile were 1.36 (95% CI, 1.16–1.59) for those in the second tertile and 1.58 (1.33–1.88) for those in the third tertile. Corresponding values were 1.36 (1.16–1.60) and 1.57 (1.33–1.87) after additional adjustment for C-reactive protein and 1.27 (1.09–1.49) and 1.31(1.10–1.57) after additional adjustment for body mass index. These results were similar for deep venous thrombosis and pulmonary embolism separately. The multivariable-adjusted hazard ratio for venous thromboembolism for a 1-g/L increase in complement C3 was 2.43 (1.74–3.40). CONCLUSIONS High concentrations of complement C3 were associated with high risk of venous thromboembolism in the general population.

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Section: Discussionmentioning

confidence: 72%

Section: Venous Thromboembolism (Deep Venous Thrombosis and Pulmonarymentioning

confidence: 99%

Complement C3 and High Risk of Venous Thromboembolism: 80517 Individuals from the Copenhagen General Population Study

2016

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“…Patients diagnosed during an emergency room visit were excluded from the cohort because of the low positive predictive value (PPV) of an SVT diagnosis in this setting. 17 We also excluded patients who were diagnosed with a DVT within 1 week of their SVT diagnosis date to avoid misclassification of SVTs that were actually DVTs.…”

Section: Study Populationmentioning

confidence: 99%

Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

Cannegieter

Horváth‐Puhó

Schmidt

et al. 2015

Blood

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Key Points• In the 3 months after isolated SVT, the risk of a deep venous event or pulmonary embolism is 3.4%.• This risk remains fivefold increased more than 5 years after the superficial event.Recently, it has become apparent that superficial vein thrombosis (SVT) can have serious complications. However, the magnitude of the risk of subsequent deep venous and arterial thrombotic events remains unknown. We examined this in a nationwide population-based setting during a period when SVT was not treated routinely with anticoagulants. The Danish National Registry of Patients, covering all Danish hospitals, was used to identify 10 973 patients with a first-time diagnosis of SVT between 1980 and 2012. A comparison cohort of 515 067 subjects, matched by age, gender, and calendar year, was selected from the general Danish population. Outcomes were venous thromboembolism, acute myocardial infarction, ischemic stroke, and death. During median follow-up of 7 years, the incidence rate of venous thromboembolism was 18.0/1000 person-years (95% confidence interval [CI], 17.2-18.9). The highest risk occurred in the first 3 months (3.4%; 95% CI, 3.0-3.7). Compared with the general population, the hazard ratio was 71.4 (95% CI, 60.2-84.7) in this period, steadily decreasing to 5.1 (95% CI 4.6-5.5), 5 years after the SVT. The hazard ratios for acute myocardial infarction, stroke, and death were 1.2 (95% CI, 1.1-1.3), 1.3 (95% CI, 1.2-1.4), and 1.3 (95% CI, 1.2-1.3), respectively, with the highest risk also shortly after SVT. These data indicate the prognostic importance of SVT and may form the basis for clinical decisionmaking regarding anticoagulation. (Blood. 2015;125(2):229-235)

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“…Information on dates and diagnoses from all clinical hospital departments in Denmark (including emergency departments and outpatients from 1995 onward, but not from general practitioners) were obtained from the 2 (17 ). This approach has previously been described by us and others (17,18 ) and was recently validated against chart review with a positive predictive value of 59% for venous thromboembolism diagnosed in any setting and 75% for venous thromboembolism diagnosed during inpatient admission (19 ).…”

Section: Deep Venous Thrombosis and Pulmonary Embolismmentioning

confidence: 99%

Increased Rheumatoid Factor and Deep Venous Thrombosis: 2 Cohort Studies of 54628 Individuals from the General Population

2015

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BACKGROUND The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease in the general population. METHODS We included 54628 participants from the Copenhagen City Heart Study (1981–83) and the Copenhagen General Population Study (2004–12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome was incident deep venous thrombosis. There were no losses to follow-up. RESULTS During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs <110 IU/mL showed the strongest association with deep venous thrombosis, with multivariable adjusted hazard ratios of 9.0 (95% CI 3.1–26) for 1-year follow-up, 4.3 (2.2–8.5) for 5-year follow-up, and 3.1 (1.7–5.6) for up to 32 years of follow-up. Compared with rheumatoid factor concentrations <15 IU/mL, the multivariable adjusted hazard ratios for deep venous thrombosis during maximum follow-up were 1.3 (1.0–1.5) for 15–29 IU/mL, 1.7 (1.0–2.8) for 30–59 IU/mL, 2.4 (1.3–4.3) for 60–119 IU/mL, and 3.0 (1.6–5.6) for ≥120 IU/mL (trend P = 6 × 10−7). Results were similar in the 2 studies separately. Obese men and women age >60 years with rheumatoid factor concentrations ≥120 IU/mL had 10% and 8% 5-year risk of deep venous thrombosis. CONCLUSIONS Increased rheumatoid factor in the general population was associated with up to 3-fold increased long-term risk and up to 9-fold increased 1-year risk of deep venous thrombosis.

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Venous thromboembolism discharge diagnoses in the Danish National Patient Registry should be used with caution

Cited by 189 publications

References 19 publications

Complement C3 and High Risk of Venous Thromboembolism: 80517 Individuals from the Copenhagen General Population Study

Complement C3 and High Risk of Venous Thromboembolism: 80517 Individuals from the Copenhagen General Population Study

Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study

Increased Rheumatoid Factor and Deep Venous Thrombosis: 2 Cohort Studies of 54628 Individuals from the General Population

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