Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case-control analysis

Abstract

Objective: To determine whether sickle cell carriers ('sickle cell trait') have an increased risk of venous thromboembolism (VTE).

Design: Cohort study with nested case-control analysis.

Setting: General population with data from 609 UK general practices in the Clinical Practice Research Datalink (CPRD).

Participants: All individuals registered with a CPRD general practice between 1998 and 2013, with a medical record of screening for sickle cell between 18 and 75 years of age.

Main outcomes measures: Incidence of VTE per 10 000 person-years (PY) among sickle cell carriers and non-carriers; and adjusted OR for VTE among sickle cell carriers compared with non-carriers.

Results: We included 30 424 individuals screened for sickle cell, with a follow-up time of 179 503 PY, identifying 55 VTEs in 6758 sickle cell carriers and 125 VTEs in 23 666 non-carriers. VTE incidence among sickle cell carriers (14.9/10 000 PY; 95% CI 11.4 to 19.4) was significantly higher than non-carriers (8.8/10 000 PY; 95% CI 7.4 to 10.4). Restricting analysis to confirmed non-carriers was non-significant, but performed on a small sample. In the case-control analysis (180 cases matched to 1775 controls by age and gender), sickle cell carriers remained at increased risk of VTE after adjusting for body mass index, pregnancy, smoking status and ethnicity (OR 1.78, 95% CI 1.18 to 2.69, p=0.006), with the greatest risk for pulmonary embolism (PE) (OR 2.27, 95% CI 1.17 to 4.39, p=0.011).

Conclusions: Although absolute numbers are small, in a general population screened for sickle cell, carriers have a higher incidence and risk of VTE, particularly PE, than non-carriers. Clinicians should be aware of this elevated risk in the clinical care of sickle cell carriers, or when discussing carrier screening, and explicitly attend to modifiable risk factors for VTE in these individuals. More complete primary care coding of carrier status could improve analysis.

Keywords: Venous thromboembolism; cohort study; sickle cell trait;.

Figure 1

Flow chart of patients in the cohort study. CPRD, Clinical Practice Research Datalink; VTE, venous thromboembolism.