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. 2013 Oct;65(10):1600-7.
doi: 10.1002/acr.22039.

Risk of venous thromboembolism in patients with rheumatoid arthritis

Seoyoung C Kim  1 , Sebastian Schneeweiss, Jun Liu, Daniel H Solomon
Affiliations

Risk of venous thromboembolism in patients with rheumatoid arthritis

Seoyoung C Kim et al. Arthritis Care Res (Hoboken). 2013 Oct.

Abstract

Objective: Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but little is known about its association with another form of vascular disorder, venous thromboembolism (VTE).

Methods: A retrospective cohort study was conducted using US insurance claims. RA and non-RA patients were matched on age, sex, and index date. Incidence rates (IRs) and rate ratios (RRs) of VTE, defined as the composite of deep vein thrombosis (DVT) or pulmonary embolism (PE), were calculated. Cox proportional hazards models compared VTE risks between RA and non-RA patients, adjusting for VTE risk factors such as CVD, surgery, hospitalization, medications, and acute-phase reactants.

Results: Over the mean followup of 2 years, the IR for VTE among RA patients was 6.1 per 1,000 person-years, 2.4 times higher (95% confidence interval [95% CI] 2.1-2.8) than the rate of non-RA patients. The IRs for both DVT (RR 2.2, 95% CI 1.9-2.6) and PE (RR 2.7, 95% CI 2.2-3.5) were higher in RA patients compared with non-RA patients. After adjusting for risk factors of VTE, the VTE risk remained elevated in RA patients (hazard ratio 1.4, 95% CI 1.1-1.7) compared to non-RA patients. The result was similar after further adjustment for elevated acute-phase reactants (hazard ratio 1.5, 95% CI 0.3-6.5). One-third of patients who developed VTE had at least 1 major VTE risk factor 90 days before and after the VTE event.

Conclusion: Our results showed an increased risk of developing VTE for RA patients compared with non-RA patients. The risk was attenuated but remained elevated even after adjusting for various risk factors for VTE.

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Conflict of interest statement

Competing interests

Liu has nothing to disclose for financial support or conflict of interest

Figures

Figure 1
Figure 1. Selection of the study cohort
The final study cohort included 22,143 RA patients and 88,572 non-RA patients matched on age, sex and index date. RA: rheumatoid arthritis, DMARD: disease-modifying antirheumatic drug, VTE: venous thromboembolism
Figure 2
Figure 2. Kaplan–Meier survival curves for hospitalization for VTE in patients with and without rheumatoid arthritis (RA)
Number of subjects at risk and events were stratified by time since the index date.
See this image and copyright information in PMC

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