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Nationwide study on the risk of unprovoked venous thromboembolism in non-traumatic osteonecrosis of femoral head

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Abstract

Purpose

Endothelial dysfunction is a risk factor for osteonecrosis of femoral head (ONFH) and venous thromboembolism (VTE) [defined as deep venous thrombosis (DVT) or pulmonary embolism (PE)]. However, the risk of unprovoked VTE in non-traumatic ONFH patients remains unclear.

Methods

We investigated the relationship between ONFH and VTE using Taiwan National Health Insurance Research Database (NHIRD). Between 1997 and 2010, a total of 1514 non-traumatic ONFH patients were identified from 1,000,000 general populations after excluding initially concomitant diagnoses of DVT and PE, and subjects undergoing lower limb surgery within one year since enrollment. The comparison group (n = 15,140) without ONFH was set up by matching study cohort with age, gender, income and urbanization in a 1:10 ratio. Subjects diagnosed with VTE within one year after surgery were also excluded.

Results

The patients with non-traumatic ONFH had significantly higher frequency of unprovoked VTE, including DVT, than general population (1.19 vs. 0.5%, p < 0.0007), whereas the frequency of PE was similar between these two groups (p = 0.4922). The cumulative incidence of VTE and DVT was also remarkably higher in the ONFH than non-ONFH group (all p < 0.001). After adjusting for age, gender, medications and comorbidities with multivariate analysis, the ONFH patients had a 2.3-fold increase in risk of DVT compared with non-ONFH counterparts (95% CI 1.28 to 4.13, p = 0.0053). Apart from ONFH, age > 65 years and hypertension were also identified as risk factors for DVT occurrence.

Conclusions

The incidence and risk of unprovoked VTE were significantly increased in the non-traumatic ONFH population.

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Abbreviations

AVN:

Avascular necrosis

ONFH:

Osteonecrosis of femoral head

NO:

Nitic oxide

VTE:

Venous thromboembolic events

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

NHIRD:

National Health Insurance Research Database

NHRI:

National Health Research Institute

RAAS:

Renin-angiotensin-aldosterone system

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Acknowledgements

We would like to thank Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taiwan for data acquisition. We also thank Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-yi Branch, Taiwan (CLRPG6G0041) for the comments and assistance in data analysis. In addition, this study was supported by a grant from Chia-yi Chang Gung Memorial Hospital, and based on the National Health Insurance Research Database offered by the Bureau of National Health Insurance, Department of Health, Taiwan. We analyzed and interpreted the retrieved data for academic purpose, and therefore the viewpoint is not represented by the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.

Author information

Author notes

  1. Pei-Hsun Sung and Hsin-Ju Chiang contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China

    Pei-Hsun Sung & Hon-Kan Yip

  2. Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Hsin-Ju Chiang

  3. Chung Shan Medical University School of Medicine, Taichung, Taiwan

    Hsin-Ju Chiang

  4. Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan

    Yao-Hsu Yang

  5. Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan

    Yao-Hsu Yang & Chi-Jen Chen

  6. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yao-Hsu Yang

  7. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

    Yao-Hsu Yang

  8. Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan

    John Y. Chiang

  9. Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan

    John Y. Chiang

  10. Institute for Translational Research in Biomedicine, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Hon-Kan Yip

  11. Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan

    Hon-Kan Yip

  12. Department of Nursing, Asia University, Taichung, Taiwan

    Hon-Kan Yip

  13. Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist, Kaohsiung city, 83301, Taiwan, Republic of China

    Mel S. Lee

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  1. Pei-Hsun Sung
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  4. John Y. Chiang
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Contributions

P.H.S and H.J.C. participated in the design of the study, data acquisition, and analysis as well as drafting the manuscript. Y.H.Y and C.J.C. were responsible for the data acquisition and troubleshooting. J.Y.C. and H.K.Y. participated in data analysis, and interpretation. M.S.L. conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hon-Kan Yip or Mel S. Lee.

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Conflict of interest

This article is the sole work of the authors. All authors report no conflict of interest.

Ethical review committee statement

This study was approved by the Ethics Institutional Review Board of Chang Gung Memorial Hospital (No. 201600738B1).

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Sung, PH., Chiang, HJ., Yang, YH. et al. Nationwide study on the risk of unprovoked venous thromboembolism in non-traumatic osteonecrosis of femoral head. International Orthopaedics (SICOT) 42, 1469–1478 (2018). https://doi.org/10.1007/s00264-018-3866-2

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  • DOI: https://doi.org/10.1007/s00264-018-3866-2

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