Atrial fibrillation associated with increased risk of venous thromboembolism

Chun-Cheng Wang; Cheng-Li Lin; Guei-Jane Wang; Chiz-Tzung Chang; Fung-Chang Sung; Chia-Hung Kao

doi:10.1160/TH14-05-0405

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(01): 185-192
DOI: 10.1160/TH14-05-0405

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH

Atrial fibrillation associated with increased risk of venous thromboembolism

A population-based cohort study

Authors

Chun-Cheng Wang

¹Graduate of Clinical Medical Science, China Medical University, Taichung, Taiwan

²Division of Cardiology, Department of Internal Medicine, Taichung Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taichung, Taiwan
Cheng-Li Lin

³Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

⁶College of Medicine, China Medical University, Taichung, Taiwan
Guei-Jane Wang

¹Graduate of Clinical Medical Science, China Medical University, Taichung, Taiwan

⁴Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

⁵Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
Chiz-Tzung Chang

⁶College of Medicine, China Medical University, Taichung, Taiwan

⁷Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
Fung-Chang Sung

⁸Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Chia-Hung Kao

⁸Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

⁹Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

Abstract

Summary

Whether atrial fibrillation (AF) is associated with an increased risk of venous thromboembolism (VTE) remains controversial. From Longitudinal Health Insurance Database 2000 (LHID2000), we identified 11,458 patients newly diagnosed with AF. The comparison group comprised 45,637 patients without AF. Both cohorts were followed up to measure the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Univariable and multivariable competing-risks regression model and Kaplan-Meier analyses with the use of Aelon-Johansen estimator were used to measure the differences of cumulative incidences of DVT and PE, respectively. The overall incidence rates (per 1,000 person-years) of DVT and PE between the AF group and non-AF groups were 2.69 vs 1.12 (crude hazard ratio [HR] = 1.92; 95 % confidence interval [CI] = 1.54-2.39), 1.55 vs 0.46 (crude HR = 2.68; 95 % CI = 1.97-3.64), respectively. The baseline demographics indicated that the members of the AF group demonstrated a significantly older age and higher proportions of comorbidities than non-AF group. After adjusting for age, sex, and comorbidities, the risks of DVT and PE remained significantly elevated in the AF group compared with the non-AF group (adjusted HR = 1.74; 95 %CI = 1.36-2.24, adjusted HR = 2.18; 95 %CI = 1.51-3.15, respectively). The Kaplan-Meier curve with the use of Aelon-Johansen estimator indicated that the cumulative incidences of DVT and PE were both more significantly elevated in the AF group than in the non-AF group after a long-term follow-up period (p<0.01). In conclusion, the presence of AF is associated with increased risk of VTE after a long-term follow-up period.

Keywords

Atrial fibrillation - venous thromboembolism - population-based cohort study - deep-vein thrombosis - pulmonary embolism

Full Text

References

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