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ABSTRACT: Patients with venous thrombosis (VT) have an increased risk of subsequent arterial cardiovascular disease (CVD), but the underlying pathophysiology is unclear. Using data from the MEGA follow-up study, 4480 patients with VT, 2926 partner controls and 2638 random digit dialing (RDD) controls were followed between 1999-2008. Incidence rates and hazard ratios (HR) with 95% confidence intervals (95%CI) of CVD (defined as myocardial infarction or ischemic stroke) were calculated for patients versus controls. Measurable confounders (age, sex, BMI, smoking, chronic disease, malignancy, genetic thrombophilia and procoagulant markers) were adjusted for when comparing patients with RDD controls. Unmeasured lifestyle-related factors were additionally considered by comparing patients with their partners. Over a median follow up time of 5 years, 124 CVD events occurred. Incidence of CVD per 1000 person years was 3.2 (95%CI, 2.5-4.0) in patients, 2.2 (95%CI, 1.5-3.0) in partners and 1.6 (95%CI, 0.9-2.6) in RDD controls. Crude HR was 2.2 (95%CI, 1.2-3.8) in patients compared with RDD controls and 1.5 (95%CI, 1.0-2.3) compared with partners. After adjustment for all abovementioned confounders, these risks attenuated to: 1.8 (95%CI, 0.8-4.2) and 1.3 (95%CI, 0.7-2.5). In conclusion, individuals with VT had an increased risk of CVD. This could be explained by common etiologic factors.
Blood 05/2013; · 9.90 Impact Factor
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Maaike G J Gademan,
Henk J van Exel,
Hedde van de Vooren,
Joris C W Haest,
Johannes van Pelt,
Arnoud van der Laarse, Suzanne C Cannegieter,
Carolien M H B Lucas,
Soeresh Somer,
Harriette F Verwey,
Martin J Schalij,
Ernst E van der Wall,
Cees A Swenne
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ABSTRACT: BACKGROUND: The mechanism of the beneficial effects of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure (CHF) is largely unexplained. In our here-presented hypothesis-generating study we propose that part of these effects is mediated by the exercise-accompanying somatosensory nerve traffic. To demonstrate this, we compared the effects of periodic electrical somatosensory stimulation in patients with CHF with the effects of exercise training and with usual care. METHODS: In a randomized controlled study we measured, in CHF patients, changes in blood pressure, baroreflex sensitivity (BRS), neurohormones, exercise capacity and quality of life (QOL) in response to periodic somatosensory stimulation in the form of 2Hz transcutaneous electrical nerve stimulation (TENS) at both feet, in response to conventional exercise training (EXTR) and, as control (CTRL), in patients with usual care only. RESULTS: Group sizes were N=31 (TENS group), N=25 (EXTR group) and N=30 (CTRL group), respectively. Practically all improvements in BRS, neurohormone concentrations, exercise capacity and QOL in the TENS group were comparable to, or sometimes even better than in the EXTR group. These improvements were not observed in the CTRL group. CONCLUSIONS: This study demonstrates that periodic electrical somatosensory stimulation is as effective as exercise training in improving BRS, neurohormone concentrations, exercise capacity and QOL in CHF patients. These results encourage exploration of exercise modalities that concentrate on rhythm rather than on effort, with the purpose to normalize autonomic derangement and neurohumoral activation in CHF.
International journal of cardiology 05/2013; · 7.08 Impact Factor
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ABSTRACT: The number of overweight and obese individuals in the population has increased dramatically in the past few decades, and the rising prevalence of obesity is a major public health concern. Growing evidence has accrued for obesity as a risk factor for venous thrombosis. The risk of venous thrombosis increases in a dose-dependent manner with increasing body mass index and is also associated with the majority of other anthropometric measures of overweight and obesity, such as waist circumference, hip circumference, and waist-to-hip ratio. An increased relative risk of both unprovoked and provoked venous thrombosis has been shown in obese compared with normal-weight subjects. However, encountering obesity as a causal factor for venous thrombosis is problematic due to the ill-defined concept of obesity. In this review, we will examine the current epidemiological evidence for an association between obesity and venous thrombosis. We will comment on the problem of causal interpretation of obesity per se and discuss how individual components that define obesity can serve as potential biological mechanisms for the observed association between obesity and venous thrombosis.
Seminars in Thrombosis and Hemostasis 04/2013; · 4.52 Impact Factor
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ABSTRACT: IMPORTANCE Excess endogenous cortisol has been linked to venous thromboembolism (VTE) risk, but whether this relationship applies to exogenous glucocorticoids remains uncertain. Because the prevalence of glucocorticoid use and the incidence of VTE are high, an increased risk of VTE associated with glucocorticoid use would have important implications. BACKGROUND To examine the association between glucocorticoid use and VTE. DESIGN Population-based case-control study using nationwide databases. SETTING Denmark (population 5.6 million). PARTICIPANTS We identified 38 765 VTE cases diagnosed from January 1, 2005, through December 31, 2011, and 387 650 population controls included through risk-set sampling and matched by birth year and sex. The VTE diagnosis date for the case was the index date for cases and matched controls. EXPOSURE We classified individuals who filled their most recent glucocorticoid prescription 90 days or less, 91 to 365 days, and more than 365 days before the index date as present, recent, and former users, respectively. Present users were subdivided into new (first-ever prescription 90 days or less before the index date) and continuing users (others). MAIN OUTCOMES AND MEASURES We used conditional logistic regression adjusted for VTE risk factors to estimate incidence rate ratios (IRRs) and 95% CIs for glucocorticoid users vs nonusers. RESULTS Systemic glucocorticoids increased VTE risk among present (adjusted IRR, 2.31; 95% CI, 2.18-2.45), new (3.06; 2.77-3.38), continuing (2.02; 1.88-2.17), and recent (1.18; 1.10-1.26) users but not among former users (0.94; 0.90-0.99). The adjusted IRR increased from 1.00 (95% CI, 0.93-1.07) for a prednisolone-equivalent cumulative dose of 10 mg or less to 1.98 (1.78-2.20) for more than 1000 to 2000 mg, and to 1.60 (1.49-1.71) for doses higher than 2000 mg. New use of inhaled (adjusted IRR, 2.21; 95% CI, 1.72-2.86) and intestinal-acting (2.17; 1.27-3.71) glucocorticoids also increased VTE risk. CONCLUSIONS AND RELEVANCE The risk of VTE is increased among glucocorticoid users. Although residual confounding may partly explain this finding, we consider a biological mechanism likely because the association followed a clear temporal gradient, persisted after adjustment for indicators of severity of underlying disease, and existed also for noninflammatory conditions. Hence, our observations merit clinical attention.
JAMA internal medicine. 04/2013;
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ABSTRACT: Context:Cushing's syndrome (CS) is associated with hypercoagulability, insulin resistance, hypertension, bone loss, and immunosuppression. To date, no adequately large cohort study has been performed to assess the multisystem effects of CS.Objective:To examine the risks for mortality, cardiovascular disease, fractures, peptic ulcers, and infections in CS patients before and after treatment.Design:Population-based cohort studySetting:Source population was the entire population of Denmark (1980 to 2010). Data were obtained from the Danish National Registry of Patients and the Danish Civil Registration System.Patients:Benign CS of adrenal or pituitary origin and a matched population comparison cohort were included.Outcome measures:We used Cox-regression, and computed hazard ratios (HR) with 95% confidence intervals (95% CI). Morbidity was investigated in the three years before diagnosis; morbidity and mortality was assessed during complete follow-up after diagnosis and treatment.Results :343 CS patients and 34,300 controls were included. Mortality was twice as high in CS patients (HR 2.3, 95%CI 1.8-2.9) compared with controls. Patients with CS were at increased risk for venous thromboembolism (HR 2.6, 95%CI 1.5-4.7), myocardial infarction (HR 3.7, 95%CI 2.4-5.5), stroke (HR 2.0, 95%CI 1.3-3.2), peptic ulcers (HR 2.0, 95%CI 1.1-3.6), fractures (HR 1.4, 95%CI 1.0-1.9), and infections (HR 4.9, 95%CI 3.7-6.4). This increased multi-morbidity risk was present before diagnosis. Mortality and risk of myocardial infarction remained elevated during long-term follow-up. Mortality and risks for AMI, VTE, stroke and infections were similarly increased in adrenal and pituitary CS.Conclusions :Despite the apparently benign character of the disease, CS is associated with clearly increased mortality and multisystem morbidity, even before diagnosis and treatment.
The Journal of clinical endocrinology and metabolism 03/2013; · 6.50 Impact Factor
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ABSTRACT: BACKGROUND: Although an association between venous thrombosis and chronic kidney disease has recently been established, it is unknown which patients with chronic kidney disease are most likely to benefit from thromboprophylaxis. OBJECTIVE: The aim of this study was to assess the association between venous thrombosis and chronic kidney disease in combination with arterial thrombosis, malignancy, surgery, and thrombophilia to identify high-risk groups as a basis for personalized prevention. METHODS: This study included 2473 consecutive patients with first venous thrombosis and 2936 controls from a case-control study (MEGA study). RESULTS: Moderately decreased kidney function (eGFR 30-60 ml/min) was associated with a 2.5-fold (95%CI 1.9-3.4) increased risk, and severely decreased kidney function (eGFR <30 ml/min) was associated with a 5.5-fold (95%CI 1.8-16.7) increased risk, all compared with those with normal kidney function (eGFR >90 ml/min). The risk of venous thrombosis was additionally increased for moderately and severely reduced kidney function in combination with arterial thrombosis (odds ratio 4.9; 95%CI 2.2-10.9), malignancy (5.8; 95%CI 2.8-12.1), surgery (14.0; 95%CI 5.0-39.4), immobilization (17.1; 95%CI 6.8-43.0), or thrombophilia (odds ratios 4.3-9.5), with particularly high risks when 3 or more risk factors were present (odds ratio 56.3; 95% CI 7.6-419.3). CONCLUSION: Decreased kidney function is associated with an increased risk of venous thrombosis. The risk increased substantially in the presence of one or more other risk factors for thrombosis. © 2013 International Society on Thrombosis and Haemostasis.
Journal of Thrombosis and Haemostasis 02/2013; · 5.73 Impact Factor
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ABSTRACT: Previous studies investigating the influence of gender on ST-segment elevation myocardial infarction have reported conflicting results. The aim of this study was to assess the influence of gender on ischemic times and outcomes after ST-segment elevation myocardial infarction in patients treated with primary percutaneous coronary intervention in modern practice. The present multicenter registry included consecutive patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention at 3 hospitals. Adjusted mortality rates were calculated using Cox proportional-hazards analyses. In total, 3,483 patients were included, of whom 868 were women (25%). Women were older, had a higher risk factor burden, and more frequently had histories of malignancy. Men more often had cardiac histories and peripheral vascular disease. Ischemic times were longer in women (median 192 minutes [interquartile range 141 to 286] vs 175 minutes [interquartile range 128 to 279] in men, p = 0.002). However, multivariate linear regression showed that this was due to age and co-morbidity. All-cause mortality was higher at 7 days (6.0% in women vs 3.0% in men, p <0.001) and at 1 year (9.9% in women vs 6.6% in men, p = 0.001). After adjustment, female gender predicted 7 day all-cause mortality (hazard ratio 1.61, 95% confidence interval 1.06 to 2.46) and cardiac mortality (hazard ratio 1.58, 95% confidence interval 1.03 to 2.42) but not 1-year mortality. Moreover, gender was an independent effect modifier for cardiogenic shock, leading to substantially worse outcomes in women. In conclusion, ischemic times remain longer in women because of age and co-morbidity. Female gender independently predicted early all-cause and cardiac mortality after primary percutaneous coronary intervention, and a strong interaction between gender and cardiogenic shock was observed.
The American journal of cardiology 11/2012; · 3.58 Impact Factor
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Suzanne C Cannegieter
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ABSTRACT: Travel-related thrombosis is a serious public health concern considering the large and increasing number of travellers. Due to a lack of evidence, counselling air travellers on their venous thrombosis risk is not immediately straightforward, and advice will have to be based mostly on theoretical grounds. In this review a basis for these considerations is given. First of all it needs to be recognized that venous thrombosis is a multicausal disease, i.e. several risk factors have to be present before an event occurs. This is reflected in the literature where clearly increased risks have been described for certain groups, such as subjects with factor V Leiden, those who use oral contraceptives or are obese. Also, an increased risk for tall and short people has been reported. So, for subjects with a known risk factor who plan to travel, benefits and risks of thrombosis prophylaxis, (pharmacological or other), need to be weighed. This review provides some theoretical examples. For all other travellers, the advice to move and exercise as much as possible is likely to be sufficient.
Best practice & research. Clinical haematology 09/2012; 25(3):345-50. · 3.13 Impact Factor
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ABSTRACT: Background. Pulmonary embolism is considered to originate from embolization of a deep-vein thrombosis, resulting in two manifestations of one disease: venous thrombosis. However, in up to 50% of patients with pulmonary embolism no deep-vein thrombosis is found with ultrasonography. An explanation for this low proportion is currently lacking. Other imaging modalities may increase deep-vein thrombosis yield in the calf or in the abdominal region. Alternatively, not all pulmonary emboli may originate from deep-vein thrombosis in the extremities. We searched for the origin of pulmonary embolism, by performing total-body Magnetic Resonance Imaging-scans to visualize thrombi. Design and Methods. 99 patients with a Computed Tomography confirmed first pulmonary embolism underwent a Magnetic Resonance Direct Thrombus Imaging-scan, a validated technique using endogenous contrast. Additionally, acquired and genetic risk factors were assessed. Results. No thrombus was found in 55 patients, leaving 44 patients with thrombus. The commonest origin was the lower leg; 12 patients had isolated calf vein thrombosis, 5 had isolated superficial vein thrombosis. Conclusions. In less than half of patients with pulmonary embolism a peripheral thrombus was found with Magnetic Resonance Imaging. We proposed several hypotheses to explain the absence of thrombi, such as cardiac thrombus origin or embolization of the complete deep-vein thrombosis. The possibility that pulmonary embolism arises de novo in the lungs, due to local inflammation driven coagulation, needs to be considered.
Haematologica 07/2012; · 6.42 Impact Factor
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ABSTRACT: Assessing whether the effect of exposure on an outcome is completely mediated by a third variable is often done by conditioning on the intermediate variable. However, when an association remains, it is not always clear how this should be interpreted. It may be explained by a causal direct effect of the exposure on the disease, or the adjustment may have been distorted due to various reasons, such as error in the measured mediator or unknown confounding of association between the mediator and the outcome.In this paper, we study various situations where the conditional relationship between the exposure and the outcome is biased due to different types of measurement error in the mediator. For each of these situations, we quantify the effect on the association parameter. Such formulas can be used as tools for sensitivity analysis or to correct the association parameter for the bias due to measurement error. The performance of the bias formulas is studied by simulation and by applying them to data from a case-control study (Leiden Thrombophilia Study) on risk factors for venous thrombosis. In this study, the question was the extent to which the relationship between blood group and venous thrombosis might be mediated through coagulation factor VIII. We found that measurement error could have strongly biased the estimated direct effect of blood group on thrombosis. The formulas we propose can be a guide for researchers who find a residual association after adjusting for an intermediate variable and who wish to explore other possible explanations before concluding that there is a direct causal effect.
Epidemiology (Cambridge, Mass.) 04/2012; 23(4):551-60. · 5.51 Impact Factor
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ABSTRACT: Risk factors for deep-vein thrombosis have been shown not to be always the same as for pulmonary embolism. A well-known example is the factor V Leiden (FVL) paradox: the FVL mutation poses a clearly higher risk for deep-vein thrombosis (DVT) than for pulmonary embolism. We aimed to expand this paradox and therefore present risk estimates for several established risk factors for DVT and pulmonary embolism separately. When such separate risk estimates could not be retrieved from the literature, we calculated these risks in our own data, a large population-based case-control study on venous thrombosis (the MEGA study). Our results showed that the FVL paradox can be broadened (ie, the risk factors oral contraceptive use, pregnancy, puerperium, minor leg injuries, and obesity have an effect comparable with FVL). Furthermore, we found that pulmonary conditions, such as chronic obstructive pulmonary disease, pneumonia, and sickle cell disease, were risk factors with an opposite effect: a higher risk of pulmonary embolism, but little or no effect on DVT. These findings suggest that pulmonary embolism and DVT may not always have the same etiology, and encourage unraveling this phenomenon in further studies.
Blood 04/2012; 120(5):933-46. · 9.90 Impact Factor
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Journal of Thrombosis and Haemostasis 04/2012; 10(6):1179-82. · 5.73 Impact Factor
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ABSTRACT: Venous thrombosis is a common disease with a high mortality rate shortly after the event. However, details on long-term mortality in these patients are lacking. The aim of this study was to determine long-term mortality in a large cohort of patients with venous thrombosis.
4,947 patients from the Multiple Environmental and Genetic Assessment study of risk factors for venous thrombosis (MEGA study) with a first nonfatal venous thrombosis or pulmonary embolism and 6,154 control individuals without venous thrombosis, aged 18 to 70 years, were followed up for 8 years. Death and causes of death were retrieved from the Dutch death registration. Standardized mortality ratios (SMRs) were calculated for patients compared with control individuals. Several subgroups were studied as well. 736 participants (601 patients and 135 controls) died over a follow-up of 54,948 person-years. The overall mortality rate was 22.7 per 1,000 person-years (95% CI 21.0-24.6) for patients and 4.7 per 1,000 person-years (95% CI 4.0-5.6) for controls. Patients with venous thrombosis had a 4.0-fold (95% CI 3.7-4.3) increased risk of death compared with controls. The risk remained increased up to 8 years after the thrombotic event, even when no additional comorbidities were present. The highest risk of death was found for patients with additional malignancies (SMR 5.5, 95% CI 5.0-6.1). Main causes of death were diseases of the circulatory system, venous thrombosis, and malignancies. Main limitation was a maximum age of 70 at time of inclusion for the first event. Therefore results can not be generalized to those in the highest age categories.
Patients who experienced a first venous thrombosis had an increased risk of death which lasted up to 8 years after the event, even when no comorbidities were present at time of thrombosis. Future long-term clinical follow-up could be beneficial in these patients. Please see later in the article for the Editors' Summary.
PLoS Medicine 01/2012; 9(1):e1001155. · 16.27 Impact Factor
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Helèn Boden,
Bas L van der Hoeven,
Su-San Liem,
Jael Z Atary, Suzanne C Cannegieter,
Douwe E Atsma,
Marianne Bootsma,
J Wouter Jukema,
Katja Zeppenfeld,
Pranobe V Oemrawsingh,
Ernst E van der Wall,
Martin J Schalij
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ABSTRACT: To evaluate the clinical outcomes of sirolimus-eluting stent (SES) versus bare metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) at long-term follow-up.
After five years, 310 STEMI patients randomly assigned to implantation of either SES or BMS, were compared. Survival rates were comparable between groups (SES 94.3% vs. BMS 92.8%, p=0.57), as were the rates of reinfarction (10.6% vs. 13.7%, p=0.40), freedom of death/re-MI (84.4% vs. 79.8%, p=0.29) and target vessel failure (14.9% vs. 21.7%, p=0.11). Likewise, rates of overall stent thrombosis (ST) (5.4% vs. 2.7%, p=0.28) and very late ST (4.1% vs. 0.7%, p=0.07) did not significantly differ between the SES- and BMS-group. In 184 patients with IVUS data, definite and definite/probable VLST was more common in those with late stent malapposition versus those without late stent malapposition (4.3% and 6.6% vs. no events [p=0.018 and p=0.004], respectively). The cumulative incidences of target vessel and target lesion revascularisation (TVR and TLR) were not significantly lower in the SES-group (11.2% vs. 17.9%, p=0.09 and 7.2% vs. 12.9%, p=0.08), as was the rate of clinically driven TLR (6.6% vs. 9.5%, p=0.30).
SES implantation was neither associated with increased rates of major adverse cardiac events, nor with a reduction in re-intervention, compared to implantation of a BMS in patients with STEMI after five years. However, a trend of more very late stent thrombosis was observed after SES implantation (ISRCTN62825862).
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 12/2011; 7(9):1021-9. · 3.29 Impact Factor
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ABSTRACT: Cardiac device infections (CDIs) are a serious complication associated with the implantation of cardiac rhythm devices. However, the effect of CDI on the subsequent risk of mortality is unknown.
To assess the prognostic importance of CDI in recipients of implantable cardioverter-defibrillator and cardiac resynchronization therapy - defibrillator.
All patients who received their initial implantable cardioverter-defibrillator/cardiac resynchronization therapy - defibrillator between January 2000 and September 2009 were included. During follow-up, the occurrence of CDI and all-cause mortality were noted. The prognostic importance of the first CDI on mortality was assessed by modeling CDI as a time-dependent covariate in the Cox proportional hazards model.
A total of 2476 patients (79% men; mean age 62 ± 13 years) were included in this analysis. During follow-up, CDI occurred in 64 (2.6%) patients. The 1-year mortality following first CDI was 16.9% (95% confidence interval 6.7%-27.1%). Experiencing the first CDI was associated with a 1.9-fold (hazard ratio 1.87; 95% confidence interval 1.07-3.26) increased risk of mortality compared to patients who did not experience CDI. After controlling for possible confounders, this increased to a 2.4-fold (hazard ratio 2.40; 95% confidence interval 1.35-4.28) increased risk of mortality.
In a large cohort of patients who receive implantable cardioverter-defibrillator/cardiac resynchronization therapy - defibrillator after their initial implant, the 3-year incidence of CDI was 2.6%. The occurrence of CDI was associated with substantial 1-year mortality, and patients experiencing CDI had a more than 2-fold increased risk of mortality compared with patients who remained free from CDI.
Heart rhythm: the official journal of the Heart Rhythm Society 11/2011; 9(4):494-8. · 4.56 Impact Factor
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ABSTRACT: Venous thrombosis and arterial thrombosis are traditionally regarded as two different diseases with respect to pathophysiology, epidemiology, and treatment strategies. Research findings of the past few years suggest that this categorical distinction may be too strict. However, whether the described relationship between venous and arterial thrombosis is real or a result of other factors such as confounding, chance, or bias is still unclear. In this review, we discuss the current literature while using causal diagrams to better understand possible causal relations between cardiovascular risk factors, atherosclerosis, arterial thrombosis, and venous thrombosis. Furthermore, we propose study designs to investigate the causal link between venous and arterial thrombosis. In addition, we comment on the effect of statin use on the occurrence of both arterial and venous thrombosis. The possible clinical implications of these findings are discussed.
Seminars in Thrombosis and Hemostasis 11/2011; 37(8):885-96. · 4.52 Impact Factor
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ABSTRACT: In elderly patients, obscurity remains regarding the benefit of implantable cardioverter-defibrillator (ICD) treatment as primary prevention of sudden cardiac death. This study assesses implant rates, therapy, adverse events, and survival gain in the elderly primary prevention ICD patient.
A total of 1395 patients treated with an ICD for primary prevention of sudden cardiac death at the Leiden University Medical Center were included and allocated to three groups according to age. Endpoints consisted of appropriate shocks and survival gain, defined as the time following first appropriate ICD shock to death. Mean follow-up was 2.9 ± 2.1 years. Fifty-one per cent of the patients were <65 years, 35% were 65-74 years, and 14% were ≥75 years. Prior to the year 2000, no ICDs were implanted in patients ≥75 years; 29% of the ICDs were implanted in patients 65-74 years. After 2005, 53% of the ICD recipients were ≥65 years at the time of implant, including 16% aged ≥75 years (P = 0.03). Five-year cumulative incidence of appropriate shocks was 19% for patients <65 years, 23% for patients 65-74 years, and 13% for patients ≥75 years (P = 0.47). At 1-year following appropriate shock, cumulative incidence for death was 35% for patients ≥75 years as compared with 7% for patients <65 years (P < 0.01).
In routine clinical practice, the percentage of patients ≥75 years receiving an ICD for primary prevention is increasing. Despite experiencing comparable rates of appropriate ICD shocks, life prolongation by ICD is significantly less in elderly as compared to younger patients.
Europace 09/2011; 14(1):66-73. · 1.98 Impact Factor
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ABSTRACT: Superficial vein thrombosis (SVT) is regarded a self-limiting disorder, although the authors of recent studies showed that ultrasonographically diagnosed SVT is a precursor for venous thrombosis. We aimed to determine whether the same holds true for clinically diagnosed SVT and to what extent it is associated with thrombophilia in a population-based case-control study (ie, Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis). We found that a history of clinical SVT was associated with a 6.3-fold (95% confidence interval [CI] 5.0-8.0) increased risk of deep-vein thrombosis and a 3.9-fold (95% CI 3.0-5.1) increased risk of pulmonary embolism. Blood group non-O and factor V Leiden showed a small increase in SVT risk in controls, with odds ratios of 1.3 (95% CI 0.9-2.0) and 1.5 (95% CI 0.7-3.3), respectively. In conclusion, clinically diagnosed SVT was a risk factor for venous thrombosis. Given that thrombophilia was only weakly associated with SVT, it is likely that other factors (varicosis, obesity, stasis) also play a role in its etiology.
Blood 08/2011; 118(15):4239-41. · 9.90 Impact Factor
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ABSTRACT: Little evidence is available regarding restrictions from driving following implantable cardioverter defibrillator (ICD) implantation or following first appropriate or inappropriate shock. The purpose of the current analysis was to provide evidence for driving restrictions based on real-world incidences of shocks (appropriate and inappropriate).
A total of 2786 primary and secondary prevention ICD patients were included. The occurrence of shocks was noted during a median follow-up of 996 days (inter-quartile range, 428-1833 days). With the risk of harm (RH) formula, using the incidence of sudden cardiac incapacitation, the annual RH to others posed by a driver with an ICD was calculated. Based on Canadian data, the annual RH to others of 5 in 100 000 (0.005%) was used as a cut-off value. In both primary and secondary prevention ICD patients with private driving habits, no restrictions to drive directly following implantation, or an inappropriate shock are warranted. However, following an appropriate shock, these patients are at an increased risk to cause harm to other road users and therefore should be restricted to drive for a period of 2 and 4 months, respectively. In addition, all ICD patients with professional driving habits have a substantial elevated risk to cause harm to other road users during the complete follow-up after both implantation and shock and should therefore be restricted to drive permanently.
The current analysis provides a clinically applicable tool for guideline committees to establish evidence-based driving restrictions.
European Heart Journal 06/2011; 32(21):2678-87. · 10.48 Impact Factor
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ABSTRACT: Several acquired risk factors for venous thrombosis (VT) are associated with high prolactin levels. Our goal was to investigate VT risk for different levels of prolactin.
We used data of a case-control study on leg vein thrombosis conducted between September 1999 and August 2006 at the Academic Medical Center, Amsterdam, the Netherlands. Prolactin was assessed in 187 cases (mean age, 57 years; range, 19 to 90) and 374 gender-matched controls (mean age, 57 years; range, 18 to 93). Odds ratios and 95% CI for VT risk were estimated based on several cutoff levels derived from prolactin levels in controls. Odds ratios for VT risk clearly increased with higher prolactin levels. For prolactin levels above the 75th percentile (8 μg/L), we found an odds ratio of 1.7 (95% CI 1.0 to 2.7) as compared with levels below the 50th percentile (6 μg/L). This further increased up to an odds ratio of 4.7 (95% CI 1.8 to 11.8) for prolactin levels above the 97.5th percentile (16 μg/L). The risk was most pronounced in premenopausal women.
Our data suggest that prolactin levels are associated with VT in a dose-dependent fashion. Future studies are needed to evaluate the causality of this relationship.
Arteriosclerosis Thrombosis and Vascular Biology 03/2011; 31(3):672-7. · 6.37 Impact Factor
