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High incidence of venous thromboembolism recurrence in patients with sickle cell disease
Author(s) -
Brunson Ann,
Keegan Theresa,
Mahajan Anjlee,
White Richard,
Wun Ted
Publication year - 2019
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25508
Subject(s) - medicine , cumulative incidence , incidence (geometry) , hazard ratio , pulmonary embolism , proportional hazards model , deep vein , acute chest syndrome , thrombosis , cohort , surgery , confidence interval , disease , sickle cell anemia , physics , optics
Abstract Previous reports show increased incidence of venous thromboembolism [VTE, deep‐vein thrombosis (DVT) and pulmonary embolus (PE)] in sickle cell disease (SCD) patients. The incidence, time course, and risk factors for VTE recurrence have been less well described. We determined the cumulative incidence of first VTE recurrence and bleeding in a cohort of SCD patients with incident VTE. Risk factors for recurrence and bleeding were also determined using multivariable Cox regression models, adjusting for gender, race/ethnicity, era of incident VTE, location and hospitalization‐associated status of incident VTE, and SCD‐related complications. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Among 877 SCD patients with an incident VTE, the 1‐year and 5‐year cumulative incidence of recurrence was 13.2% (95% CI 11.0%‐15.5%) and 24.1% (95% CI 21.2%‐27.1%). Risk factors for VTE recurrence included more severe SCD (HR = 2.41; CI: 1.67‐3.47), lower extremity DVT as the incident event (HR = 1.64; CI: 1.17‐2.30), and pneumonia/acute chest syndrome (HR = 1.68; CI: 1.15‐2.45). The cumulative incidence of bleeding was 4.9% (CI 3.5%‐6.4%) at 6 months and 7.9% (CI: 6.2%‐9.8%) at 1 year. More severe SCD (HR = 1.61; CI: 1.11‐2.35) was associated with bleeding. The high incidence of VTE recurrence in patients with SCD suggests that extended anticoagulation may be indicated; however, this must be weighed against a relatively high risk of bleeding. Prospective, randomized studies of anticoagulation in SCD patients with VTE are needed.