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. 2020 Apr 9;4(4):628-635.
doi: 10.1002/rth2.12333. eCollection 2020 May.

Increased risk of thrombotic events in cold agglutinin disease: A 10-year retrospective analysis

Catherine M Broome  1 , Julia M Cunningham  1 , Megan Mullins  2   3 , Xiaohui Jiang  3 , Lauren C Bylsma  3 , Jon P Fryzek  3 , Adam Rosenthal  4
Affiliations

Increased risk of thrombotic events in cold agglutinin disease: A 10-year retrospective analysis

Catherine M Broome et al. Res Pract Thromb Haemost. .

Abstract

Background: Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia mediated by IgM autoantibodies that trigger hemolysis via classical complement pathway. Increased incidence of thrombotic events (TEs) has been reported in patients with other forms of hemolysis. The incidence of TEs in patients with CAD is unknown.

Objective: Evaluate TE risk in patients with CAD.

Patients/methods: This is a matched cohort comparison study evaluating the risk of TEs in patients with CAD and without CAD over a 10-year period. A total of 608 patients with CAD were identified in the Optum Claims-Clinical data set by reviewing clinical notes for CAD terms and matched with up to 10 patients without CAD (N = 5873). TEs were defined as the first medical claim for a TE using International Classification of Diseases, Ninth and Tenth Revision codes. Cox regression models were used to estimate time to first TE. Sensitivity analyses were conducted to estimate TE risk among patients with primary CAD.

Results: At least 1 TE occurred in 29.6% of patients with CAD and 17.6% of patients without CAD. The proportion of patients experiencing venous, arterial, and cerebral TEs were each higher among CAD patients. The overall risk of having TEs was higher in patients with CAD (adjusted hazard ratio [aHR], 1.94; 95% confidence interval [CI], 1.64-2.30). Patients with presumed primary CAD also demonstrated an increased risk of TEs (aHR, 1.80; 95% CI, 1.46-2.22). Patients with CAD with the fewest comorbidities had 2.44-fold higher risk of having a TE (95% CI, 1.70-3.52).

Conclusions: Patients with CAD have an increased risk of TEs when compared with a matched non-CAD population.

Keywords: hemolytic anemia; autoimmune anemia; classical complement pathway; retrospective analysis; thrombosis.

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Figures

Figure 1
Figure 1
Cumulative incidence curve of first thrombotic event (TE) after index date in patients with CAD and patients without CAD. CAD, cold agglutinin disease
See this image and copyright information in PMC

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