Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis

Little, Iain; Vinogradova, Yana; Orton, Elizabeth; Kai, Joe; Qureshi, Nadeem

doi:10.1136/bmjopen-2016-012665

Cited by 28 publications

(31 citation statements)

References 55 publications

(47 reference statements)

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“…In the seven studies carried out in the general adult populations [ 21 – 27 ], the proportion of female varied from 25.0 to 100%. Seven studies were from the USA [ 21 – 25 , 29 , 30 ], one from the UK [ 26 ], one from Nigeria [ 27 ], and one from Brazil [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

“…Acute and chronic vessel occlusion could cause significant complications in various organs including the brain (strokes or silent brain infarcts), the kidneys (renal infarction with papillary necrosis or medullar fibrosis), the bones (aseptic osteonecrosis, pain crises), the spleen (spleen infarcts), the retina (retinopathy), the lungs (acute chest syndrome) or the male external genitalia (priapism) [ 3 – 5 ]. Some studies have also suggested an increased risk of venous thromboembolism (VTE) in patients with SCD or sickle cell trait (SCT) [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis

et al. 2018

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BackgroundGlobally, sickle cell disease (SCD) is one of the most common haemoglobinopathy. Considered a public health problem, it leads to vessel occlusion, blood stasis and chronic activation of the coagulation system responsible for vaso-occlussive crises and venous thromboembolism (VTE) which may be fatal. Although contemporary observational studies suggest a relationship between SCD or sickle trait (SCT) and VTE, there is lack of a summary or meta-analysis data on this possible correlation. Hence, we propose to summarize the available evidence on the association between SCD, SCT and VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe searched PubMed and Scopus to identify all cross-sectional, cohort and case-control studies reporting on the association between SCD or SCT and VTE, DVT or PE in adults or children from inception to April 25, 2017. For measuring association between SCD or SCT and VTE, DVT, or PE, a meta-analysis using the random-effects method was performed to pool weighted odds ratios (OR) of risk estimates.ResultsFrom 313 records initially identified from bibliographic databases, 10 studies were eligible and therefore included the meta-analysis. SCD patients had significantly higher risk for VTE (pooled OR 4.4, 95%CI 2.6–7.5, p < 0.001), DVT (OR 1.1, 95% CI 1.1–1.2, p < 0.001) and PE (pooled OR 3.7, 95% CI 3.6–3.8, p < 0.001) as compared to non SCD-adults. A higher risk of VTE (OR 33.2, 95% CI 9.7–113.4, p < 0.001) and DVT (OR 30.7, 95% CI 1.6–578.2, p = 0.02) was found in pregnant or postpartum women with SCD as compared to their counterparts without SCD. Compared to adults with SCT, the risk of VTE was higher in adults with SCD (pooled OR 3.1, 95% CI 1.8–5.3, p < 0.001), and specifically in SCD pregnant or postpartum women (OR 20.3, 95% CI 4.1–102, p = 0.0003). The risk of PE was also higher in adults with SCD (OR 3.1, 95% CCI 1.7–5.9, p = 0.0004) as compared to those with SCT. The risk of VTE was higher in individuals with SCT compared to controls (pooled OR 1.7, 95% CI 1.3–2.2, p < 0.0001), but not in pregnant or postpartum women (OR 0.9, 95% CI 0.3–2.9, p = 0.863). Compared to controls, SCT was associated with a higher risk of PE (pooled OR 2.1, 95% CI 1.2–3.8, p = 0.012) but not of DVT (pooled OR 1.2, 95% CI 0.9–1.7, p = 0.157).ConclusionIndividuals with SCD, especially pregnant or postpartum women, might have a higher risk of VTE compared to the general population. SCT might also increases the risk of VTE. However, currently available data are not sufficient to allow a definite conclusion. Further larger studies are needed to provide a definitive conclusion on the association between SCD, SCT and VTE.Electronic supplementary materialThe online version of this article (10.1186/s12959-018-0179-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis

et al. 2018

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“…8 Low oxygen tension within venous valves of the lower extremities may predispose to overt sickling and increased coagulation activity. 18 In a large general population cohort of 30,424 individuals, the risk of VTE and, in particular, pulmonary embolism was 2-times higher in SCT individuals than in people with a normal hemoglobin variant. 18 A similar risk has been described in hospitalized patients with SCT.…”

Section: Venous Thromboembolismmentioning

confidence: 98%

“…18 In a large general population cohort of 30,424 individuals, the risk of VTE and, in particular, pulmonary embolism was 2-times higher in SCT individuals than in people with a normal hemoglobin variant. 18 A similar risk has been described in hospitalized patients with SCT. 7 Currently, there are no data on the benefits of routine SCT testing as part of the thrombophilia workup in patients presenting with VTE; however, it appears prudent to consider SCT as a possible risk factor for VTE and counsel individuals with SCT about avoiding conditions that may increase thrombotic risk (eg, prolonged immobility).…”

Section: Venous Thromboembolismmentioning

confidence: 98%

Sickle Cell Trait: What Every Nurse Practitioner Should Know

Benenson¹,

Porter²,

Vitale³

2018

The Journal for Nurse Practitioners

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Sickle cell trait is a carrier state for the b-chain sickle hemoglobin mutation. Individuals with sickle cell trait have normal life expectancy and no symptoms of sickle cell disease, with the exception of some rare but serious complications such as renal abnormalities, venous thromboembolism, and exercise-related injuries. Sickle cell trait has important reproductive consequences, with a risk of having a child with sickle cell disease. Nurse practitioners should be aware of the screening, potential complications, and routine management of individuals with sickle cell trait in order to provide evidence-based care to this population.

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“…There may be more challenges than advantages presented by incidental findings of Hb variants, some of which are discussed here. (33), and whether health records of who has SCT are sufficiently robust (34). Although identifying which professional or organization is best placed to inform patients of their newly discovered status is important, it is also possible that appropriate access to services such as genetic counseling may not be available.…”

Section: Ethical Challenges Presented By Incidental Findings Of Sct Tmentioning

confidence: 99%

Incidental Findings of Sickle Cell Trait From an Everyday Diabetes Test: Should General Health Care Providers and Testing Centers Report, Retest, or Refer?

et al. 2020

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The A1C (HbA1c test) is increasingly used as a diagnostic and screening test for type 2 diabetes (T2DM). With an estimated 8.8% of adults globally having diabetes, effective screening, diagnosis, and monitoring is of major global importance (1). The biomarker of A1C refers to glycated hemoglobin A molecules and has gained prominence in the diagnosis of type 2 diabetes because it offers certain advantages over plasma glucose testing regimens (2). It is well established that some of the hundreds of hemoglobin (Hb) variants, including the clinically relevant HbS, HbE, HbC, and HbD (3,4) may interfere with the validity of A1C results. Thus, testing strategies and tools employing A1C should ideally identify variants when they are present. Incidental findings of Hb variants present several ethical challenges for laboratories, health care providers, patients, and their families. These challenges have, to date, received little attention. This article reviews some of the advantages of detecting sickle cell trait,

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Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis

Cited by 28 publications

References 55 publications

Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis

Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis

Sickle Cell Trait: What Every Nurse Practitioner Should Know

Incidental Findings of Sickle Cell Trait From an Everyday Diabetes Test: Should General Health Care Providers and Testing Centers Report, Retest, or Refer?

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