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Thromb Haemost 2019; 119(08): 1358-1364
DOI: 10.1055/s-0039-1692176
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Myocardial Infarction as a Transient Risk Factor for Incident Venous Thromboembolism: Results from a Population-Based Case–Crossover Study

Joakim K. Sejrup
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
,
Trond Børvik
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
,
Gro Grimnes
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
,
Trond Isaksen
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
,
Kristian Hindberg
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
,
John-Bjarne Hansen
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
,
Vania M. Morelli
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
,
Sigrid K. Brækkan
1   K.G. Jebsen-Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
2   Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
› Author Affiliations Funding The K.G. Jebsen-Thrombosis Research and Expertise Center is supported by an independent grant from Stiftelsen Kristian Gerhard Jebsen.
Further Information

Publication History

11 February 2019

12 April 2019

Publication Date:
16 June 2019 (online)

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Abstract

Patients with myocardial infarction (MI) are at increased short-term risk of venous thromboembolism (VTE). The mechanisms behind this association are unclear. We aimed to investigate the impact of acute MI as a transient risk factor for incident VTE while taking other concomitant VTE risk factors into account. We conducted a case–crossover study of VTE patients (n = 707) recruited from the fourth survey of the Tromsø Study. VTE risk factors and hospitalizations were registered during the 90-day period preceding the VTE diagnosis (hazard period) and in four 90-day control periods. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for VTE according to acute MI and after adjustment for other risk factors. Additionally, we applied a mediation analysis to quantify how much the known transient risk factors account for the observed effect of MI on VTE risk. MI was recorded in 13 (1.8%) of the hazard periods and in 6 (0.2%) of the control periods, which yielded a crude OR of 11.9 (95% CI: 3.9–36.7). Adjustment for immobilization and infection yielded an OR of 2.7 (95% CI: 0.6–11.2). The OR was attenuated to 2.6 (95% CI: 0.6–11.9) after further adjustment for major surgery, trauma, red blood cell transfusion, and central venous catheterization. Approximately 60% of the association between MI and VTE was mediated through infection and immobilization. In conclusion, our findings suggest that the increased VTE risk after MI may to a large extent be explained by concomitant conditions related to MI, particularly infections and immobilization.

Keywords

venous thromboembolism - myocardial infarction - transient risk factor - infection - immobilization

Authors' Contributions

J.K.S. contributed to statistical analysis, data interpretation, and drafted the manuscript. T.B., G.G., and T.I. contributed to data collection, data interpretation, and revision of the manuscript. K.H. contributed to statistical analysis, data interpretation, and revision of the manuscript. J.B.H. and V.M.M. contributed to the conception and design of the study, data interpretation, and revision of the manuscript. S.K.B. contributed to the conception and design of the study, data collection, statistical analysis, data interpretation, and revision of the manuscript. All authors reviewed and approved the final version of the manuscript.


Supplementary Material

 

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