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AMSTERDAM – Adult patients who become hospitalized and have sickle cell disease have about a sixfold increased risk of developing venous thromboembolism during the following weeks and months, compared with hospitalized patients without sickle cell disease, in a case-control study of more than 25,000 people admitted to or seen at California hospitals during 1990-2010.
Since 46% of the venous thromboembolism (VTE) episodes in patients with sickle cell disease happened within 30 days of a hospitalization or emergency department visit, the painful, inflammatory episodes that often drive patients with sickle cell disease to seek hospitalization may also provoke VTE said Dr. Ted Wun and his associates in a poster presented at a congress of the International Society on Thrombosis and Haemostasis. Relative immobilization during hospitalization may also play a role in triggering VTE in these patients, suggesting that "robust" thromboprophylaxis be applied to patients with sickle cell disease who enter a hospital, said Dr. Wun, professor of medicine and chief of hematology and oncology at the University of California, Davis, in Sacramento.
The analysis also showed the impact of VTE episodes. After 10 years of follow-up, cumulative mortality was just under 20% in patients with sickle cell disease who did not have a VTE, and more than 40% in patients who had a VTE, a statistically significant difference in an actuarial analysis.
The risk for VTE posed by sickle cell disease was even higher in the 42% of patients with severe sickle cell disease, defined as patients who had three or more hospitalizations or emergency department visits during the prior year. Patients in the severe subgroup had a 9.5-fold higher rate of VTE, compared with controls who had no sickle cell disease. Among the 58% of sickle cell patients without severe disease, the incidence of VTE was fourfold greater than among those without sickle cell disease.
Dr. Wun and his associates used data collected in the California Patient Discharge Dataset and in California’s Emergency Department Utilization database. They identified 4,280 patients 18-65 years old with sickle cell disease who were either hospitalized or seen at an emergency department during 1990-2010. They matched each of these sickle cell patients with five patients hospitalized or seen at emergency departments who did not have sickle cell disease. Matching included age, sex, race, ethnicity, and year of index event. The researchers could track each of the more than 25,000 total patients through subsequent hospitalizations and emergency-department visits by their unique identifier codes.
The patients with sickle cell disease averaged 28 years old, 91% were black, and during follow-up they had an 8% incidence of VTE.
The analysis also showed that comorbidities increased the risk for VTE, although not as strongly as sickle cell disease. For the entire group of more than 25,000 patients having three or more comorbidities linked with a threefold higher rate of VTEs, compared with those without any comorbidities. Among only patients with sickle cell disease, having three or more comorbidities boosted the VTE rate by a statistically-significant 67%, compared with sickle cell patients without any comorbidities. Female sex also significantly linked with a boosted VTE rate among patients with sickle cell disease. Women with sickle cell disease had 43% more VTE episodes than did men with sickle cell disease in the adjusted analysis.
Dr. Wun had no disclosures.
On Twitter @mitchelzoler
AMSTERDAM – Adult patients who become hospitalized and have sickle cell disease have about a sixfold increased risk of developing venous thromboembolism during the following weeks and months, compared with hospitalized patients without sickle cell disease, in a case-control study of more than 25,000 people admitted to or seen at California hospitals during 1990-2010.
Since 46% of the venous thromboembolism (VTE) episodes in patients with sickle cell disease happened within 30 days of a hospitalization or emergency department visit, the painful, inflammatory episodes that often drive patients with sickle cell disease to seek hospitalization may also provoke VTE said Dr. Ted Wun and his associates in a poster presented at a congress of the International Society on Thrombosis and Haemostasis. Relative immobilization during hospitalization may also play a role in triggering VTE in these patients, suggesting that "robust" thromboprophylaxis be applied to patients with sickle cell disease who enter a hospital, said Dr. Wun, professor of medicine and chief of hematology and oncology at the University of California, Davis, in Sacramento.
The analysis also showed the impact of VTE episodes. After 10 years of follow-up, cumulative mortality was just under 20% in patients with sickle cell disease who did not have a VTE, and more than 40% in patients who had a VTE, a statistically significant difference in an actuarial analysis.
The risk for VTE posed by sickle cell disease was even higher in the 42% of patients with severe sickle cell disease, defined as patients who had three or more hospitalizations or emergency department visits during the prior year. Patients in the severe subgroup had a 9.5-fold higher rate of VTE, compared with controls who had no sickle cell disease. Among the 58% of sickle cell patients without severe disease, the incidence of VTE was fourfold greater than among those without sickle cell disease.
Dr. Wun and his associates used data collected in the California Patient Discharge Dataset and in California’s Emergency Department Utilization database. They identified 4,280 patients 18-65 years old with sickle cell disease who were either hospitalized or seen at an emergency department during 1990-2010. They matched each of these sickle cell patients with five patients hospitalized or seen at emergency departments who did not have sickle cell disease. Matching included age, sex, race, ethnicity, and year of index event. The researchers could track each of the more than 25,000 total patients through subsequent hospitalizations and emergency-department visits by their unique identifier codes.
The patients with sickle cell disease averaged 28 years old, 91% were black, and during follow-up they had an 8% incidence of VTE.
The analysis also showed that comorbidities increased the risk for VTE, although not as strongly as sickle cell disease. For the entire group of more than 25,000 patients having three or more comorbidities linked with a threefold higher rate of VTEs, compared with those without any comorbidities. Among only patients with sickle cell disease, having three or more comorbidities boosted the VTE rate by a statistically-significant 67%, compared with sickle cell patients without any comorbidities. Female sex also significantly linked with a boosted VTE rate among patients with sickle cell disease. Women with sickle cell disease had 43% more VTE episodes than did men with sickle cell disease in the adjusted analysis.
Dr. Wun had no disclosures.
On Twitter @mitchelzoler
AMSTERDAM – Adult patients who become hospitalized and have sickle cell disease have about a sixfold increased risk of developing venous thromboembolism during the following weeks and months, compared with hospitalized patients without sickle cell disease, in a case-control study of more than 25,000 people admitted to or seen at California hospitals during 1990-2010.
Since 46% of the venous thromboembolism (VTE) episodes in patients with sickle cell disease happened within 30 days of a hospitalization or emergency department visit, the painful, inflammatory episodes that often drive patients with sickle cell disease to seek hospitalization may also provoke VTE said Dr. Ted Wun and his associates in a poster presented at a congress of the International Society on Thrombosis and Haemostasis. Relative immobilization during hospitalization may also play a role in triggering VTE in these patients, suggesting that "robust" thromboprophylaxis be applied to patients with sickle cell disease who enter a hospital, said Dr. Wun, professor of medicine and chief of hematology and oncology at the University of California, Davis, in Sacramento.
The analysis also showed the impact of VTE episodes. After 10 years of follow-up, cumulative mortality was just under 20% in patients with sickle cell disease who did not have a VTE, and more than 40% in patients who had a VTE, a statistically significant difference in an actuarial analysis.
The risk for VTE posed by sickle cell disease was even higher in the 42% of patients with severe sickle cell disease, defined as patients who had three or more hospitalizations or emergency department visits during the prior year. Patients in the severe subgroup had a 9.5-fold higher rate of VTE, compared with controls who had no sickle cell disease. Among the 58% of sickle cell patients without severe disease, the incidence of VTE was fourfold greater than among those without sickle cell disease.
Dr. Wun and his associates used data collected in the California Patient Discharge Dataset and in California’s Emergency Department Utilization database. They identified 4,280 patients 18-65 years old with sickle cell disease who were either hospitalized or seen at an emergency department during 1990-2010. They matched each of these sickle cell patients with five patients hospitalized or seen at emergency departments who did not have sickle cell disease. Matching included age, sex, race, ethnicity, and year of index event. The researchers could track each of the more than 25,000 total patients through subsequent hospitalizations and emergency-department visits by their unique identifier codes.
The patients with sickle cell disease averaged 28 years old, 91% were black, and during follow-up they had an 8% incidence of VTE.
The analysis also showed that comorbidities increased the risk for VTE, although not as strongly as sickle cell disease. For the entire group of more than 25,000 patients having three or more comorbidities linked with a threefold higher rate of VTEs, compared with those without any comorbidities. Among only patients with sickle cell disease, having three or more comorbidities boosted the VTE rate by a statistically-significant 67%, compared with sickle cell patients without any comorbidities. Female sex also significantly linked with a boosted VTE rate among patients with sickle cell disease. Women with sickle cell disease had 43% more VTE episodes than did men with sickle cell disease in the adjusted analysis.
Dr. Wun had no disclosures.
On Twitter @mitchelzoler
AT ISTH 2013