Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study.

Segna, Daniel; Méan, Marie; Limacher, Andreas; Baumgartner, Christine; Blum, Manuel R; Beer, Jürg-Hans; Kucher, Nils; Righini, Marc; Matter, Christian M; Frauchiger, Beat; Cornuz, Jacques; Aschwanden, Markus; Banyai, Martin; Osterwalder, Joseph; Husmann, Marc; Egloff, Michael; Staub, Daniel; Lämmle, Bernhard; Angelillo, Anne; Aujesky, Drahomir; ... (2016). Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study. Journal of thrombosis and haemostasis, 14(4), pp. 685-694. Wiley-Blackwell 10.1111/jth.13276

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BACKGROUND Venous thromboembolism (VTE) and subclinical thyroid dysfunction (SCTD) are both common in elderly patients. SCTD has been related to a hypercoagulable state and increased thromboembolic risk. However, prospective data on the relationship between SCTD and VTE are lacking. OBJECTIVES To investigate the relationship between SCTD and recurrent VTE (rVTE), all-cause mortality, and thrombophilic biomarkers. PATIENTS Elderly participants with VTE. METHODS In a prospective multicenter cohort, thyroid hormones and thrombophilic biomarkers were measured 1 year after acute VTE, as both may be influenced by acute thrombosis. We defined subclinical hypothyroidism (SHypo) as elevated thyroid stimulating hormone levels (TSH=4.50-19.99 mIU/l), and subclinical hyperthyroidism (SHyper) as TSH<0.45, both with normal free thyroxine levels. Outcomes were incidence of rVTE and overall mortality during follow-up starting after the 1-year blood sampling. RESULTS Of 561 participants (58% with anticoagulation), 6% had SHypo and 5% SHyper. After 20.8 months of mean follow-up, 9% developed rVTE and 10% died. rVTE incidence rate was 7.2 (95% confidence interval:2.7-19.2) per 100 patient-years in SHypo, 0.0 (0.0-7.6) in SHyper and 5.9 (4.4-7.8) in euthyroid participants. In multivariate analyses, the sub-hazard ratio [SHR] for rVTE was 0.00 (0.00-0.58) in SHyper and 1.50 (0.52-4.34) in SHypo compared to euthyroids, without increased thrombophilic biomarkers. SHyper (HR 0.80,0.23-2.81) and SHypo (HR 0.99,0.30-3.29) were not associated with mortality. CONCLUSION In elderly patients, SHyper may be associated with lower rVTE risks. SHypo showed a non-statistically significant pattern of an association with rVTE, without increased mortality or differences in thrombophilic biomarkers. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene)

UniBE Contributor:

Segna, Daniel; Méan Pascual, Marie; Limacher, Andreas; Baumgartner, Christine; Blum, Manuel; Kucher, Nils; Lämmle, Bernhard; Angelillo, Anne; Aujesky, Drahomir and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1538-7836

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Verena Zwahlen

Date Deposited:

24 Mar 2016 16:20

Last Modified:

16 Jul 2018 14:21

Publisher DOI:

10.1111/jth.13276

PubMed ID:

26816339

Uncontrolled Keywords:

Cohort Studies; Hyperthyroidism; Hypothyroidism; Thyroid Diseases; Venous Thromboembolism

BORIS DOI:

10.7892/boris.79304

URI:

https://boris.unibe.ch/id/eprint/79304

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