Venous thromboembolism in anti-neutrophil cytoplasmic antibody-associated vasculitis: an underlying prothrombotic condition?

Antovič, Aleksandra; Svensson, Einar; Lövström, Björn; Illescas, Vera Bäckström; Nordin, Annika; Börjesson, Ola; Arnaud, Laurent; Bruchfeld, Annette; Gunnarsson, Iva

doi:10.1093/rap/rkaa056

Cited by 11 publications

(14 citation statements)

References 37 publications

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“…61% of the VTE episodes in this study occurred within the rst 12 months following diagnosis of AAV where disease activity and in ammation are high. This temporal relationship has also been observed in recent studies suggesting that in ammation and a pro-thrombotic state must be considered (3,4). The majority of the VTE episodes that occurred later in the disease course were around the time of severe infection, malignancy, or relapse of AAV, all of which can be associated with an elevation of in ammation and thus promote thrombosis.…”

Section: Discussionsupporting

confidence: 69%

“…Venous thromboembolism (VTE) in patients with AAV is common with previous studies identifying a 4fold increased risk in AAV compared with the general population. Furthermore, VTE adds to the considerable morbidity and mortality within this vulnerable population (3)(4)(5)(6)(7)(8). A number of studies have indicated that the highest risk of VTE occurs during periods of disease activity when in ammation is high, although patients with AAV remain hypercoagulable even during remission (3, 5-7, 9, 10).…”

Section: Introductionmentioning

confidence: 99%

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Cytomegalovirus Infection Is A Risk Factor For Venous Thromboembolism In ANCA-Associated Vasculitis

King

Patel²,

Mendoza³

et al. 2022

Preprint

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Background: Venous thromboembolism (VTE) is a common complication in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) and confers significant morbidity and mortality. Both acute and past cytomegalovirus (CMV) infection have been identified as risk factors for VTE in immunocompetent and immunosuppressed individuals. Here we examine whether past exposure to CMV is a risk factor for VTE amongst patients with AAV.Methods: We retrospectively analysed outcomes of patients with a new diagnosis of AAV from a local cohort. All confirmed cases of VTE where CMV IgG serology was available at diagnosis were recorded. Retrospective collection of the same data for patients at a North American centre was used as a validation cohort.Results: VTE was common with 12% of patients from the study cohort (total 259 patients) developing an event during the median follow up period of 8.5 years of which 60% occurred within the first 12 months following diagnosis. 16% of CMV seropositive patients developed a VTE compared with 5% of patients who were seronegative (p=0.007) and CMV seropositivity remained an independent predictor of VTE in multivariable analysis (HR 2.96 [1.094-8.011] p=0.033). CMV seropositivity at diagnosis was confirmed as a significant risk factor for VTE in the American validation cohort (p=0.032).Conclusions: VTE is common in patients with AAV, especially within the first year of diagnosis. Past infection with CMV is an independent risk factor associated with VTE in AAV.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus Infection Is A Risk Factor For Venous Thromboembolism In ANCA-Associated Vasculitis

King

Patel²,

Mendoza³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Venous thromboembolism (VTE) in patients with AAV is common with previous studies identifying a 4-fold increased risk in AAV compared with the general population. Furthermore, VTE adds to the considerable morbidity and mortality within this vulnerable population [ 3 – 8 ]. A number of studies have indicated that the highest risk of VTE occurs during periods of disease activity when inflammation is high, although patients with AAV remain hypercoagulable even during remission [ 3 , 5 – 7 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, VTE adds to the considerable morbidity and mortality within this vulnerable population [ 3 – 8 ]. A number of studies have indicated that the highest risk of VTE occurs during periods of disease activity when inflammation is high, although patients with AAV remain hypercoagulable even during remission [ 3 , 5 – 7 , 9 , 10 ]. Several mechanisms have been described to explain this thrombotic tendency associated with AAV.…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus infection is a risk factor for venous thromboembolism in ANCA-associated vasculitis

et al. 2022

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Background Venous thromboembolism (VTE) is a common complication in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) and confers significant morbidity and mortality. Both acute and past cytomegalovirus (CMV) infection have been identified as risk factors for VTE in immunocompetent and immunosuppressed individuals. Here, we examine whether past exposure to CMV is a risk factor for VTE amongst patients with AAV. Methods We retrospectively analysed outcomes of patients with a new diagnosis of AAV from a UK cohort. All confirmed cases of VTE where CMV IgG serology was available were recorded. Retrospective collection of the same data for patients at a North American centre was used as a validation cohort. Results VTE was common with 12% of patients from the study cohort (total 259 patients) developing an event during the median follow-up period of 8.5 years of which 60% occurred within the first 12 months following diagnosis. Sixteen percent of CMV seropositive patients developed a VTE compared with 5% of patients who were seronegative (p = 0.007) and CMV seropositivity remained an independent predictor of VTE in multivariable analysis (HR 2.96 [1.094–8.011] p = 0.033). CMV seropositivity at diagnosis was confirmed as a significant risk factor for VTE in the American validation cohort (p = 0.032). Conclusions VTE is common in patients with AAV, especially within the first year of diagnosis. Past infection with CMV is an independent risk factor associated with VTE in AAV.

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“…The AAV diagnostic groups were divided into subgroups (GPA, MPA,and EGPA) according to the European Medicines Agency (EMEA) algorithm, and all were ANCA positive at the time of diagnosis [ 14 ]. The data collection and the cohort have been described in a previous publication [ 15 ]. For the present study, additional exclusion criteria were added: insufficient knowledge of and inability to read and understand written Swedish.…”

Section: Methodsmentioning

confidence: 99%

Exploring the educational needs of patients with systemic vasculitis using the educational needs assessment tool

Brolin

Henriksson

Lövström

et al. 2022

Rheumatology Advances in Practice

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Objectives Knowledge and health literacy enable patients to monitor symptoms and disease impact. Educational needs have previously been explored in rheumatology, but scarcely for patients with antineutrophilic cytoplasmatic antibody (ANCA)-associated vasculitis (AAV). The aim of the study was to assess the educational needs among patients with AAV using the Educational Needs Assessment Tool (ENAT). Methods A cross-sectional observational study included adults with AVV. Educational needs were captured by ENAT. Total ENAT (0–117 points, higher numbers indicating higher educational need) and the seven domains (managing pain, movement, feelings, disease process, treatment, self-management and, support systems) were explored regarding sex, age, education, diagnosis, disease duration and disease activity. To compare domains a percentage response (0–100%) was calculated. Results Individuals (n = 178), men 50%, 34% with disease duration ≤2 years were included. The total ENAT mean was 66.5 ± 26.6 (57%) and domains; ‘Disease process’ 78%, ‘Self-management’ 69%, ‘Treatments’ 64%, ‘Feelings’ 56%, ‘Managing pain’ 48%, ‘Support systems’ 47% and ‘Movement’ 41%. Higher educational needs were found among women in the domains ‘Movement’, ‘Feelings’, ‘Disease process’ and in total ENAT (all p < 0.04) compared with men. Higher educational needs were also seen in patients with disease duration ≤ 2 years regarding ‘Disease process’, ‘Self-management’, ‘Support systems’ and in total ENAT compared with patients with longer disease duration (all p < 0.03). Conclusion This study revealed great educational needs among AVV. Some groups express higher needs (women and those with shorter disease duration). Increased education for patients with AAV may lead to improved self-care and treatment adherence.

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Venous thromboembolism in anti-neutrophil cytoplasmic antibody-associated vasculitis: an underlying prothrombotic condition?

Cited by 11 publications

References 37 publications

Cytomegalovirus Infection Is A Risk Factor For Venous Thromboembolism In ANCA-Associated Vasculitis

Cytomegalovirus Infection Is A Risk Factor For Venous Thromboembolism In ANCA-Associated Vasculitis

Cytomegalovirus infection is a risk factor for venous thromboembolism in ANCA-associated vasculitis

Exploring the educational needs of patients with systemic vasculitis using the educational needs assessment tool

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