Background/Purpose: Venous thromboembolism (VTE) encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE) is the third most common cause of death related to cardiovascular disease following stroke and heart attack. Studies in the past have shown an increased association with the common inflammatory rheumatological disorders, however they still remain under-recognized as risk factors for VTE. We examined the risk of VTE among hospitalized spondyloarthritis patients in a large inpatient US database.

Methods: Using the National Inpatient Sample (NIS) data from 2006-2011, we identified VTE related hospitalizations (DVT or PE as primary diagnosis) and selected patients with spondyloarthritis, malignancy and osteoarthritis based ICD-9 codes. NIS is the largest publicly available all-payer inpatient care database in US. Discrete cohorts of patients with spondyloarthropathies (SpA), osteoarthritis (OA), malignancy and control group were created after excluding all hospitalizations with other common rheumatological diseases such as (RA, SLE, myositis, APS, vasculitis). Univariate and multivariate logistic regressions (adjusted for age, sex, race, obesity, from nursing home, long bone fractures, prior malignancy, post-surgery status, DM, CHF, respiratory failure, spinal cord injury, prior VTE, hypercoagulability, smoking, length of stay ≥ 3 days, calendar year, venous catheterizations and infections) were used to derive odds ratio for measures of association. SVY function was used in STATA version 13.0 to make weighted estimation for the whole US population.

Results:

Our study included 29,116 hospitalizations (weighted N= 143,650) with spondyloarthritis from 2006-2011. The rates of VTE related hospitalizations was comparable between SpA and malignancy (1.50 % vs 1.54 %). Adjusted OR of VTE among patients with SpA was close to that of malignancy ( 1.30 (1.17-1.4) vs 1.31 (1.29-1.33)), while that of osteoarthritis was 0.81 (0.79-0.83) (Table 1).

Conclusion:

It has been shown that inflammation drives thrombosis with imbalance between innate pro-coagulants, anti-coagulants and fibrinolysis. Alarmingly elevated risk of VTE among inflammatory rheumatological diseases are reported and our study is in line with the same. We found a relatively high risk of VTE among patients hospitalized with SpA, which was comparable with that of malignancy (Table 1). This raises an argument as to whether an inflammatory rheumatological disease like SpA should be considered as an independent risk factor for VTE among hospitalized patients. Given the large, rising burden of rheumatological diseases and its proven associations with VTE, it appears prudent to include these in the pre-test probability calculators such as Well’s or other validated scores for VTE. The weightage or score to be given should be guided by future large, prospective trials.

Table 1: Proportion and odds of association of Spondyloarthritides with VTE

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-venous-thromboembolism-with-spondyloarthopathies-among-hospitalized-patients-data-from-national-inpatient-sample/