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. 2021 Jun;19(6):1519-1525.
doi: 10.1111/jth.15302. Epub 2021 Apr 9.

Severe alpha-1-antitrypsin deficiency increases the risk of venous thromboembolism

Nawfal Basil  1 , Magnus Ekström  2 , Eeva Piitulainen  1 , Anne Lindberg  3 , Eva Rönmark  4 , Lars Jehpsson  5 , Hanan Tanash  1
Affiliations
Free article

Severe alpha-1-antitrypsin deficiency increases the risk of venous thromboembolism

Nawfal Basil et al. J Thromb Haemost. 2021 Jun.
Free article

Abstract

Background: Severe alpha-1-antitrypsin deficiency (AATD), phenotype PiZZ, is associated with increased risk of liver disease and chronic obstructive pulmonary disease (COPD), but the risk of venous thromboembolism (VTE) is unknown. Our aim was to evaluate the risk of VTE in individuals with severe AATD compared with control subjects from the general population.

Methods: Individuals with severe AATD (n = 1577) were recruited from the Swedish national AATD register. Control subjects (n = 5969) were selected from the OLIN (Obstructive Lung Disease in Northern Sweden) studies, that include a random general population sample. Longitudinal data on VTE and diagnoses were obtained from the Swedish National Patient Registry. Associations were analyzed using multivariable Cox regression.

Results: At inclusion, 46% of the AATD individuals and 53% of the controls were never-smokers. COPD was present in 46% of the AATD individuals compared with 4% of the controls. During a median follow-up of 18 years, 116 (7%) of the AATD individuals and 89 (1%) of the control subjects developed VTE, unadjusted hazard ratio 6.5 (95% confidence interval 4.9-8.6). Risk factors for incident VTE were male gender, age, COPD, cancer, and liver disease. Adjusting for these factors, the AATD individuals had a significantly higher risk of incident VTE, adjusted hazard ratio 4.2 (95% confidence interval 2.9-6.2) as compared with the controls.

Conclusion: Subjects with severe AATD have considerably increased risk of developing VTE compared with the general population, even after accounting for risk factors. This calls for optimized risk factor management and clinical follow-up of this patient group.

Keywords: COPD; alpha-1-antitrypsin deficiency; deep vein thrombosis; pulmonary embolism; venous thromboembolism.

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References

REFERENCES

    1. American Thoracic Society; European Respiratory Society. American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. Am J Respir Crit Care Med. 2003;168(7):818-900.
    1. Lomas DA. The selective advantage of alpha1-antitrypsin deficiency. Am J Respir Crit Care Med. 2006;173(10):1072-1077. https://doi.org/10.1164/rccm.200511-1797PP
    1. Greulich T, Nell C, Hohmann D, et al. The prevalence of diagnosed α1-antitrypsin deficiency and its comorbidities: results from a large population-based database. Eur Respir J. 2017;49(1):1600154. https://doi.org/10.1183/13993003.00154-2016
    1. Elsensohn AN, Curtis JA, Secrest AM, et al. Alpha-1-antitrypsin deficiency panniculitis presenting with severe anasarca, pulmonary embolus and hypogammaglobulinaemia. Br J Dermatol. 2015;173(1):289-291. https://doi.org/10.1111/bjd.13611
    1. Fiechtner JJ, Magnin GE. Multiple pulmonary thromboemboli and pneumothorax. Complications of exogenous estrogen in an alpha-1-antitrypsin deficient woman. Wis Med J. 1978;77(10):S103-S106.

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