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Multicenter Study
. 2015 Jan;13(1):2-9.
doi: 10.1111/jth.12787. Epub 2014 Dec 11.

Prospective study of sickle cell trait and venous thromboembolism incidence

A R Folsom  1 , W Tang, N S Roetker, A V Kshirsagar, V K Derebail, P L Lutsey, R Naik, J S Pankow, M L Grove, S Basu, N S Key, M Cushman
Affiliations
Multicenter Study

Prospective study of sickle cell trait and venous thromboembolism incidence

A R Folsom et al. J Thromb Haemost. 2015 Jan.

Abstract

Background: Sickle cell trait may increase risk of venous thromboembolism, but this is not fully established.

Objectives: We sought to determine the association of sickle cell trait with deep vein thrombosis and pulmonary embolism.

Methods: Middle-aged African Americans participating in a prospective, population-based cohort investigation, the Atherosclerosis Risk in Communities Study, were followed from 1987 through 2011 for incident hospitalized pulmonary embolism (n = 111) or isolated deep vein thrombosis (n = 138), verified by physician review of medical records. Sickle cell trait (heterozygosity for hemoglobin S, n = 268) was compared with no sickle cell trait (n = 3748).

Results: Over a median of 22 years of follow-up, 249 participants had an incident venous thromboembolism. The hazard ratio of venous thromboembolism was 1.50 (95% confidence interval [CI] 0.96-2.36) for participants with vs. without sickle cell trait, after adjustment for age, sex, ancestry, hormone replacement therapy (women), body mass index, diabetes, and estimated glomerular filtration rate. This hazard ratio was 2.05 (95% CI 1.12-3.76) for pulmonary embolism and 1.15 (95% CI 0.58-2.27) for deep vein thrombosis without pulmonary embolism.

Conclusions: Sickle cell trait in African Americans carries a 2-fold increased risk of pulmonary embolism but does not elevate deep vein thrombosis risk. Because neonatal screening for sickle hemoglobin is being conducted in the United States, consideration should be paid to the increased pulmonary embolism risk of individuals with sickle cell trait.

Keywords: epidemiology; prospective study; risk factors; sickle cell trait; venous thromboembolism.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival probabilities for (a) venous thromboembolism (VTE), (b) pulmonary embolism (PE) with or without deep vein thrombosis (DVT), and (c) isolated DVT, comparing participants with sickle cell trait versus no sickle cell trait, ARIC, 1987-2011.
See this image and copyright information in PMC

References

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