Thromb Haemost 2018; 118(11): 1918-1929
DOI: 10.1055/s-0038-1673694
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Role of Routine Laboratory Tests in Assessing Risk of Recurrent Venous Thrombosis: Results from the MEGA Follow-Up Study

Vânia M. Morelli
1  Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Willem M. Lijfering
1  Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
2  Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
,
Suely M. Rezende
3  Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Astrid van Hylckama Vlieg
1  Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Frits R. Rosendaal
1  Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
2  Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
,
Suzanne C. Cannegieter
1  Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
2  Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
4  Department of Internal Medicine, Section of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
Funding This work was supported by the Netherlands Heart Foundation (grants NHS98.113, NHS2010B167, NHS208B086 and NHS2011T012), the Dutch Cancer Foundation (grant RUL 99/1992) and the Netherlands Organization for Scientific Research (grant 912–03–033|2003).
Further Information

Publication History

04 May 2018

11 August 2018

Publication Date:
24 October 2018 (online)

Abstract

Background Kidney function, measured as estimated glomerular filtration rate (eGFR), glucose levels and haematologic variables (blood cell count) are easily obtainable tests, and have been associated with increased risk of first venous thrombosis (VT). Whether these routine tests can identify patients at risk of recurrence is unclear.

Aim Our aim was to investigate the predictive value of serum glucose levels, eGFR and haematologic variables in patients at risk of recurrent VT.

Methods Patients with a first VT were followed from discontinuation of anticoagulant treatment. Percentile categories of eGFR, glucose levels and haematologic variables were established. Crude incidence rates with 95% confidence intervals (CIs) of recurrence were estimated in each percentile category. Cox regression models were used to compare groups, adjusted for age and sex.

Results Of 2,106 patients followed for a median of 6.9 years, 326 developed recurrence (incidence rate, 2.7/100 patient-years; 95% CI, 2.5–3.1). The adjusted hazard ratio for recurrence was 1.5 (95% CI, 0.9–2.4) in the lowest eGFR percentile category (< 59 mL/min/1.73 m2) versus the reference (≥86 mL/min/1.73 m2). Stratification by unprovoked or provoked first events yielded similar results. The combination of a first unprovoked VT with renal dysfunction was associated with a threefold increased risk of recurrence compared with those with first provoked VT and normal kidney function (hazard ratio, 3.1, 95% CI, 1.6–5.9). Glucose levels and haematologic variables were not associated with increased recurrence risk.

Conclusion Testing glucose levels and haematologic variables did not identify patients at increased risk of recurrent VT. Renal dysfunction tests may have some predictive value, particularly in combination with other variables.

Authors' Contributions

V.M. Morelli had full access to the database, performed the statistical analysis, interpreted the data and drafted the manuscript. W.M. Lijfering designed the analysis, had full access to the database, supervised the statistical analysis, interpreted the data and revised the manuscript. S.M. Rezende interpreted the data and revised the manuscript. A. van Hylckama Vlieg interpreted the data and revised the manuscript. F.R. Rosendaal was responsible for the MEGA study concept and design, interpreted the data and revised the manuscript. S.C. Cannegieter designed the analysis, interpreted the data and revised the manuscript. All authors read and approved the final version of the manuscript.


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