Seasonal and monthly variability in the incidence of venous thromboembolism

Francesco Dentali; Walter Ageno; Elena Rancan; Alberto V. Donati; Luca Galli; Alessandro Squizzato; Achille Venco; Pier Mannuccio Mannucci; Roberto Manfredini

doi:10.1160/TH11-02-0116

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(03): 439-447
DOI: 10.1160/TH11-02-0116

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Seasonal and monthly variability in the incidence of venous thromboembolism

A systematic review and a meta-analysis of the literature

Authors

Francesco Dentali

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Walter Ageno

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Elena Rancan

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Alberto V. Donati

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Luca Galli

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Alessandro Squizzato

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Achille Venco

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Pier Mannuccio Mannucci

²Department of Medicine and Medical Specialties, IRCCS Cà Granda Foundation Maggiore Policlinico Hospital, Milan Italy
Roberto Manfredini

³Department of Clinical and Experimental Medicine, Clinica Medica and Vascular Diseases Center, University of Ferrara, Italy

Abstract

Summary

Many studies showed that the occurrence of cardiovascular and cerebrovascular events exhibits a seasonal and monthly variation. Evidences of a seasonal and monthly variation in the incidence of venous thromboembolism (VTE) are more conflicting. We conducted a systematic review and a meta-analysis of the literature to assess the presence of an infradian rhythm of this disease. MEDLINE and EMBASE databases were searched up to January 2010. Monthly and seasonal variation in the incidence of VTE were analysed. We included studies analysing seasonal or monthly aggregation in the incidence of deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) with an objective diagnosis of VTE. Two authors independently reviewed and extracted data. Seventeen studies for a total of about 35,000 patients were included. Twelve studies analysed the seasonal variation and 10 studies the monthly variation of VTE. Our results showed a significantly increased incidence of VTE in winter (chi-square 146.04, p <0.001), with a relative risk (RR) of VTE of 1.143 (99% CI [1.141, 1.144]), and a significantly increased incidence of VTE in January (chi-square 232.57, p <0.001) with an RR of VTE of 1.194 (99% CI 1.186, 1.203). Subgroup analyses including only idiopathic venous thromboembolic events confirmed the results of principal analyses. In conclusion, our data support the presence of an infradian pattern in the incidence of venous thromboembolic events, with a significantly higher risk in Winter and in January. Future studies are needed to better clarify the mechanisms behind this pattern.

Keywords

Venous thromboembolism - seasonal - monthly

Full Text

References

References
1 Ornato JP, Peberdy MA, Chandra NC. et al. Seasonal patter of acute myocardial infarction in the National Registry of Myocardial Infarction. J Am Coll Cardiol 1996; 28: 1684-1688.
2 Spencer FA, Goldberg RJ, Becker RC. for the participants in the National Registry of Myocardial Infarction. J Am Coll Cardiol 1998; 31: 1226-1233.
3 Manfredini R, Boari B, Smolensky MH. et al. Seasonal in onset of myocardial infarction – a 7 years single-center study in Italy. Chronobiol Int 2005; 22: 1121-1135.
4 Manfredini R, Manfredini F, Boari B. et al. Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction. Am J Emerg Med 2009; 27: 1097-1103
5 Arntz HR, Willich SN, Schreiber C. et al. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24061 consecutive cases. Eur Heart J 2000; 21: 315-320.
6 Boulay F, Berthier F, Sisteron O. et al. Seasonal variation in chronic heart failure hospitalizations and mortality in France. Circulation 1999; 100: 280-286.
7 Feldman DE, Platt R, Dery V. et al. Seasonal congestive heart failure mortality and hospitalization trends, Quebec 1990-1998. J Epidemiol Community Health 2004; 58: 129-130.
8 Mehta RH, Manfredini R, Hassan F. et al International Registry of Acute Aortic Dissection (IRAD) Investigators. Chronobiological patterns of acute aortic dissection. Circulation 2002; 106: 1110-1115.
9 Mehta RH, Manfredini R, Bossone E. et al International Registry of Acute Aortic Dissection (IRAD) Investigators. The winter peak in the occurrence of acute aortic dissection is independent by climate. Chronobiol Int 2005; 22: 723-729.
10 Gallerani M, Manfredini R, Ricci L. et al. Chronobiological aspects of acute cerebrovascural diseases. Acta Neurol Scand 1993; 87: 482-487.
11 Gallerani M, Portaluppi F, Maida G. et al. Circadian and circannual rhythmicity in the occurrence of subarachnoid hemorrhage. Stroke 1996; 27: 1793-1797.
12 Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke 1998; 29: 992-996.
13 Cohen MC, Rohtla KM, Lavery CE. et al. Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 1997; 79: 1512-1516.
14 Tan XY, He JG, Zou ZP. et al. Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1874 to 2005. Chin Med J 2006; 119: 998-1002.
15 Ferrari E, Baudouy M, Cerboni P. et al. Clinical epidemiology of venous thromboembolic disease. Results of a French Multicentre Registry. Eur Heart J 1997; 18: 685-691.
16 Santiago JM, Garcia GR, Dominguez AM. Variaciones estacionales en la morbimortalidad por tromboembolismo pulmonary en Galicia. An Mad Interna 2003; 20: 457-460.
17 Green J, Edwards C. Seasonal variation in the necropsy incidence of massive pulmonary embolism. J Clin Pathol 1994; 47: 58-60.
18 Masotti L, Ceccarelli E, Forconi S. et al. Seasonal variation of pulmonary embolism in hospitalized patients. Resp Med 2005; 99: 1469-1473.
19 Bilora F, Boccioletti V, Manfredini E. et al. Seasonal variation in the incidence of deep vein thrombosis in patients with deficiency of protein C or protein S. Clin Appl Thromb Hemost. 2002; 8: 231-237.
20 Chau XY, Yuen ST, Wong MP. Seasonal variation in the necropsy incidence of pulmonary thromboembolism in Hong Kong. J Clin Pathol 1995; 48: 578-579.
21 Meral M, Mirici A, Aslan S. et al. Barometric pressure and the incidence of pulmonary embolism. Chest 2005; 128: 2190-2194.
22 Lucena J, Rico A, Vazquez R. et al. Pulmonary embolism and sudden – unexpected death: prospective study on 2477 forensic autopsies performed at the Istitute of Legal Medicine in Seville. J Forensic Leg Med 2009; 16: 196-201.
23 Galle C, Wautrecht JC, Motte S. et al. Role de la saison dans l’incidence de la thrombose veineuse profonde. Mal Vas 1998; 23: 99-101.
24 Bilora F, Manfredini R, Petrobelli F. et al. Chronobiology of non fatal pulmonary thromboembolism. Panminerva Med 2001; 43: 7-10.
25 Gallerani M, Boari B, de Toma D. et al. Seasonal variation in the occurrence of deep vein thrombosis. Med Sci Monit. 2004; 10: CR191-196.
26 Hakim H, Samadikhah J, Alizadehasl A. et al. Chronobiological thythms in the onset of massive pulmonary embolism in Iranian population. Middle East J Anesthesiol 2009; 20: 369-375.
27 Manfredini R, Gallerani M, Salmi R. et al. Fatal pulmonary embolism in Hospitalized patients: evidence for a winter peak. J Int Med Res 1994; 22: 85-89.
28 Oztuna F, Ozsu S, Topbas M. et al. Meteorological parameters and seasonal variations in pulmonary thromboembolism. Am J Emerg Med 2008; 26: 1035-1040.
29 Gallerani M, Boari B, Smolensky MH. et al. Seasonal variation in occurrence of pulmonary embolism: analysis of the database of the Emilia-Romagna region, Italy. Chronobiol Int 2007; 24: 143-160.
30 Manfredini R, Gallerani M, Boari B. et al. Seasonal variation in onset of pulmonary embolism is independent of patients’ underlying risk comorbid conditions. Clin Appl Thromb Hemost. 2004; 10: 39-43.
31 Kunes J, Tremblay J, Bellavance F. et al. Influence of environmental temperature on the blood pressure of hypertensive patients in Montreal. Am J Hypertens 1991; 4: 422-426.
32 Sharma BK, Sagar S, Sood GK. et al. Seasonal variations of arterial blood pressure in normotensive and essential hypertensives. Indian Heart J 1990; 42: 66-72.
33 Gordon DJ, Hyde J, Trast DC. Cyclic seasonal variation in plasma lipids and lipoprotein levels. The Lipid Research Clinics Coronary Primary Prevention Trial Placebo Group. J Clin Epidemiol 1988; 41: 679-689.
34 Imamura M, Biro S, Kihara T. et al. Repeated thermal therapy improves impaired vascular endothelial function in patients with coronary risk factors. J Am Coll Cardiol 2001; 38: 1083-1099.
35 Kihara T, Biro S, Imamura M. et al. Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. J Am Coll Cardiol 2002; 39: 754-759.
36 Sung KC. Seasonal variation of C-reactive protein in apparently healthy Koreans. Int J Cardiol 2006; 107: 338-342.
37 Rudnicka AR, Rumley A, Lowe GOD. et al. Diurnal, seasonal, and blood-processing patterns in levels of circulating fibrinogen, fibrin D-dimer, C-reactive protein, tissue plasminogen activator, and von Willebrand factor in a 45-year-old population. Circulation 2007; 115: 996-1003.
38 Stout R, Crawford V. Seasonal variation in fibrinogen concentration among elderly people. Lancet 1991; 338: 9-12.
39 Van der Bom JG, de Maat MPM, Bots ML. et al. Seasonal variation in fibrinogen in the Rotterdam study. Thromb Haemost 1997; 78: 1059-1062.
40 Woodhouse PR, Khaw KT, Plummer M. et al. Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: winter infections and death from cardiovascular disease. Lancet 1994; 343: 435-439.
41 Hermida RC, Calvo C, Ayala DE. et al. Seasonal variation of fibrinogen in dipper and nondipper hypertensive patients. Hypertension 2003; 108: 1101-1106.
42 Bull GM, Brozovic M, Chakrabarti R. Relationship of air temperature to various chemical, haematological, and haemostatic variables. J Clin Pathol 1979; 32: 16-20.
43 Keatinge WR, Coleshaw SR, Cotter F. et al. Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. Br Med J 1984; 289: 1405-1408.
44 Ageno W, Becattini C, Brighton T. et al. Cardiovascular risk factors and venous thromboembolism. A meta-analysis. Circulation 2008; 117: 93-102.
45 Franchini M, Mannucci PM. Particulate air pollution and cardiovascular risk: short-term and long-term effects. Semin Thromb Hemost 2009; 35: 665-670.
46 Franchini M, Mannucci PM. Short-term effects of air pollution on cardiovascular diseases: outcomes and mechanisms. J Thromb Haemost 2007; 5: 2169-2174.
47 Baccarelli A, Zanobetti A, Martinelli I. et al. Effects of exposure to air pollution on blood coagulation. J Thromb Haemost 2007; 5: 252-260.
48 Baccarelli A, Martinelli I, Zanobetti A. et al. Exposure to particulate air pollution and risk of deep vein thrombosis. Arch Intern Med 2008; 168: 920-927.
49 Dales RE, Cakmak S, Vidal CB. Air pollution and hospitalization for venous thromboembolic disease in Chile. J Thromb Haemost 2010; 8: 669-674.
50 Manfredini R, Gallerani M, Salmi R. et al. Circadian rhythms and the heart: implications for chronotherapy of cardiovascular diseases. Clin Pharmacol Ther 1994; 56: 244-247.
51 Sewlall S, Pillay V, Danckwerts MP. et al. A timely review of state-of-the-art chronopharmaceuticals synchronized with biological rhythms. Curr Drug Deliv 2010; 7: 370-388.
52 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. J Am Med Assoc 2000; 283: 2008-2012.