Is Infection an Independent Risk Factor for Venous Thromboembolism? a Population-Based Case-Control Study

The independent association of recent infection with venous thromboembolism is uncertain. The purpose of the study was to test both overall infection (site unspecified) and specific infection sites as potential risk factors for deep vein thrombosis and pulmonary embolism adjusting for other known venous thromboembolism factors.

Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident deep vein thrombosis or pulmonary embolism over the 13-year period, 1988-2000 (cases; n=1303), and 1-2 residents without venous thromboembolism matched to each case on age, sex and incident venous thromboembolism date (controls; n=1494). These case-control sets were analyzed using conditional logistic regression. Data were collected on recent infection and infection site(s), body mass index, smoking, current or recent hospitalization with and without surgery, nursing home confinement, active cancer, trauma or fracture, leg paresis, prior superficial vein thrombosis, transvenous catheter/pacemaker, ischemic heart disease, congestive heart failure, chronic lung or renal disease, serious liver disease, asthma, diabetes mellitus, hormone therapy, and among women, hormonal contraception and pregnancy/post-partum.

Five hundred thirteen (39.4%) cases and 189 (12.7%) controls had an infection in the previous 92 days (OR=4.5; 95%CI: 3.6, 5.5; p<0.0001). In a multivariable analysis adjusting for common venous thromboembolism risk factors, pneumonia as well as symptomatic urinary tract, oral, intra-abdominal and systemic blood stream infections were associated with significantly increased odds of venous thromboembolism.

Infection as a whole, as well as specific infection sites in particular are independent risk factors for venous thromboembolism and should be considered as potential indications for venous thromboembolism prophylaxis.

The American journal of medicine. 2017 Oct 04 [Epub ahead of print]

Kevin P Cohoon, Aneel A Ashrani, Daniel J Crusan, Tanya M Petterson, Kent R Bailey, John A Heit

Department of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Electronic address: ., Department Division of Hematology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA., Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA., Department of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department Division of Hematology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine; and the Divisions of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.

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