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Thromb Haemost 2020; 120(01): 156-167
DOI: 10.1055/s-0039-1697664
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Blood Transfusion and Risk of Venous Thromboembolism: A Population-Based Cohort Study

Shih-Yi Lin‡   ∗
1   Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
2   Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
,
Yun-Lung Chang‡   ∗
1   Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
2   Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
,
Hung-Chieh Yeh
1   Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
2   Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
,
Cheng-Li Lin
3   Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
4   College of Medicine, China Medical University, Taichung, Taiwan
,
Chia-Hung Kao
1   Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
5   Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
6   Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
7   Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
› Author Affiliations Funding This work was supported by grants from the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212–133004); China Medical University Hospital (CMU106-ASIA-12, DMR-107–192); Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 107–2321-B-039 -004-); Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in the study design, data collection, and analysis.
Further Information

Publication History

09 March 2019

16 August 2019

Publication Date:
22 October 2019 (online)

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Abstract

Background The risk of venous thromboembolism (VTE) in generally ill patients, both under outpatient and inpatient care, following blood transfusion has not been determined.

Methods This retrospective population-based cohort study was conducted using the National Health Insurance Research Database. We studied patients who received blood transfusion, defined as red blood cell transfusion of any type, from January 1, 2000 to December 31, 2011. The index date was defined as the date of blood transfusion. The primary outcome was VTE. Propensity score matching and Cox proportional hazard models were used.

Results A total of 41,866 patients who underwent blood transfusion and 41,866 matched controls were studied. Generally, the blood transfusion cohort has 2.98 times higher risk of VTE than the control cohort (95% confidence interval [CI] = 1.23–7.22). The blood transfusion cohort had respectively 1.99 and 1.64 times higher risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) compared with the control cohort (DVT, 95% CI = 1.65–2.41; PE, 95% CI = 1.19–2.26). Patients in the blood transfusion cohort who did not use warfarin were 1.95 times more likely to develop VTE than those in the control cohort (adjusted hazard ratio [HR]: 1.95, 95% CI = 1.65–2.31). Patients in the blood transfusion cohort were 1.74 times more likely to die than those in the control cohort (adjusted HR: 1.74, 95% CI = 1.48–2.05).

Conclusion Blood transfusion is associated with an increased risk of VTE. The risk of VTE decreased in those who took warfarin.

Keywords

venous thromboembolism - deep vein thrombosis - pulmonary embolism - blood transfusion

Authors' Contributions

Conception/Design: S.-Y.L., C.-H.K.; Provision of study materials: C.-H.K.; Collection and/or assembly of data: S.-Y.L., C.-L.L., C.-H.K.; Data analysis and interpretation: S.-Y.L., C.-L.L., C.-H.K.; Manuscript writing: S.-Y.L., Y.-L.C., H.-C.Y., C,-L.L., C.-H.K.; Final approval of manuscript: S.-Y.L., Y.-L.C., H.-C.Y., C.-L.L., C.-H.K.


∗ Shih-Yi Lin and Yun-Lung Chang equally contributed to this article.


 

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