Seasonal and monthly variability in the incidence of venous thromboembolism. A systematic review and a meta-analysis of the literature

Abstract

Many studies showed that the occurrence of cardiovascular and cerebrovascular events exhibits a seasonal and monthly variation. Evidences of a seasonal and monthly variation in the incidence of venous thromboembolism (VTE) are more conflicting. We conducted a systematic review and a meta-analysis of the literature to assess the presence of an infradian rhythm of this disease. MEDLINE and EMBASE databases were searched up to January 2010. Monthly and seasonal variation in the incidence of VTE were analysed. We included studies analysing seasonal or monthly aggregation in the incidence of deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) with an objective diagnosis of VTE. Two authors independently reviewed and extracted data. Seventeen studies for a total of about 35,000 patients were included. Twelve studies analysed the seasonal variation and 10 studies the monthly variation of VTE. Our results showed a significantly increased incidence of VTE in winter (chi-square 146.04, p <0.001), with a relative risk (RR) of VTE of 1.143 (99% CI [1.141, 1.144]), and a significantly increased incidence of VTE in January (chi-square 232.57, p <0.001) with an RR of VTE of 1.194 (99% CI 1.186, 1.203). Subgroup analyses including only idiopathic venous thromboembolic events confirmed the results of principal analyses. In conclusion, our data support the presence of an infradian pattern in the incidence of venous thromboembolic events, with a significantly higher risk in Winter and in January. Future studies are needed to better clarify the mechanisms behind this pattern.