The Role of Stroke as a Trigger for Incident Venous Thromboembolism: Results from a Population-based Case-Crossover Study

Vânia M. Morelli; Joakim K. Sejrup; Birgit Småbrekke; Ludvig B. Rinde; Gro Grimnes; Trond Isaksen; John-Bjarne Hansen; Kristian Hindberg; Sigrid K. Brækkan

doi:10.1055/s-0039-1681020

TH Open, Table of Contents

CC BY 4.0 · TH Open 2019; 03(01): e50-e57
DOI: 10.1055/s-0039-1681020

Original Article

Georg Thieme Verlag KG Stuttgart · New York

The Role of Stroke as a Trigger for Incident Venous Thromboembolism: Results from a Population-based Case-Crossover Study

Authors

Vânia M. Morelli

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
Joakim K. Sejrup

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
Birgit Småbrekke

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
Ludvig B. Rinde

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
Gro Grimnes

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

²Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
Trond Isaksen

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

²Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
John-Bjarne Hansen

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

²Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
Kristian Hindberg

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

²Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
Sigrid K. Brækkan

¹K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

²Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway

Abstract

Stroke is associated with a short-term increased risk of subsequent venous thromboembolism (VTE). It is unclear to what extent this association is mediated by stroke-related complications that are potential triggers for VTE, such as immobilization and infection. We aimed to investigate the role of acute stroke as a trigger for incident VTE while taking other concomitant VTE triggers into account. We conducted a population-based case-crossover study with 707 VTE patients. Triggers were registered during the 90 days before a VTE event (hazard period) and in four preceding 90-day control periods. Conditional logistic regression was used to estimate odds ratios with 95% confidence intervals (CIs) for VTE according to triggers. Stroke was registered in 30 of the 707 (4.2%) hazard periods and in 6 of the 2,828 (0.2%) control periods, resulting in a high risk of VTE, with odds ratios of 20.0 (95% CI: 8.3–48.1). After adjustments for immobilization and infection, odds ratios for VTE conferred by stroke were attenuated to 6.0 (95% CI: 1.6–22.1), and further to 4.0 (95% CI: 1.1–14.2) when other triggers (major surgery, red blood cell transfusion, trauma, and central venous catheter) were added to the regression model. A mediation analysis revealed that 67.8% of the total effect of stroke on VTE risk could be mediated through immobilization and infection. Analyses restricted to ischemic stroke yielded similar results. In conclusion, acute stroke was a trigger for VTE, and the association between stroke and VTE risk appeared to be largely mediated by immobilization and infection.

Keywords

venous thromboembolism - stroke - risk factor - immobilization - infection

Full Text

References

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