Summary
Rheumatoid arthritis is not generally considered to be a risk factor for venous thromboembolism
(VTE), although abnormalities of coagulation factors have been found in patients with
rheumatoid arthritis. Sparse data in a few patients suggest that patients with rheumatoid
arthritis may have higher rates of VTE. The purpose of this investigation was to determine
if the incidences of pulmonary embolism (PE) and deep venous thrombosis (DVT) are
increased in hospitalized patients with rheumatoid arthritis. The number of patients
discharged from non-Federal short-stay hospitals throughout the United States from
1979 through 2005 with a discharge code for rheumatoid arthritis was obtained from
the National Hospital Discharge Survey (NHDS). Among hospitalized patients with rheumatoid
arthritis who did not have joint surgery, 41,000 of 4,818,000 (0.85%) had PE compared
with 3,366,000 of 891,055,000 (0.38%) among patients who did not have rheumatoid arthritis
and who did not have operations or joint surgery (relative risk =2.25). Deep venous
thrombosis was diagnosed in 79,000 of 4,818,000 (1.64%) patients with rheumatoid arthritis
and no joint operation, versus 7,681,000 of 891,055,000 (0.86%) who did not have rheumatoid
arthritis or a joint operation (relative risk=1.90). The relative risk of venous thromboembolism
(PE and/or DVT) in these patients was 1.99. The data suggest that rheumatoid arthritis
is a risk factor for VTE in hospitalized medical patients. A heightened awareness
of the risks for VTE and a lower threshold for evaluation of patients for possible
DVT or PE would be appropriate in caring for hospitalized patients with rheumatoid
arthritis.
Keywords
Pulmonary embolism - deep venous thrombosis - venous thromboembolism - rheumatoid
arthritis