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Journal of Thrombosis and Thrombolysis

, Volume 41, Issue 3, pp 404–412 | Cite as

Infection as cause of immobility and occurrence of venous thromboembolism: analysis of 1635 medical cases from the RIETE registry

  • Stefania Frasson
  • Gualberto Gussoni
  • Pierpaolo Di Micco
  • Raquel Barba
  • Laurent Bertoletti
  • Manuel J. Nuñez
  • Beatriz Valero
  • Angel Luis Samperiz
  • Agustina Rivas
  • Manuel Monreal
  • The RIETE Investigators
Article

Abstract

Several risk assessment models include infection and immobility among the items to be considered for venous thromboembolism (VTE) prevention. However, information on patients with infection leading to immobility and developing VTE are limited, as well as on the role of specific types of infection. Data were collected from the worldwide RIETE registry, including patients with symptomatic objectively confirmed VTE, and followed-up for at least 3 months. The overall population of RIETE at June 2013 (n = 47,390) was considered. Acute infection leading to immobility was reported in 3.9 % of non-surgical patients. Compared with patients immobilized due to dementia, patients with infection had a shorter duration of immobilization prior to VTE (less than 4 weeks in 94.2 vs. 25.9 % of cases; p < 0.001). During the 3-month follow-up, VTE patients with infection versus those with dementia had a lower rate of fatal bleeding (0.5 vs. 1.1 %; p < 0.05) or fatal PE (1.7 vs. 3.5 %; p < 0.01). Patients with respiratory tract infections had more likely PE as initial VTE presentation than other types of infection (62.3 vs. 37.7 %; p < 0.001). Significantly more patients with pneumonia than those with other respiratory infections had received VTE prophylaxis (50.2 vs. 30.6 %; p < 0.001). Following VTE, patients with sepsis showed a significantly higher risk of fatal bleeding. Based on our real-world data, infection seems to contribute to the pathogenesis of VTE by accelerating the effects of immobility. Its role as VTE risk factor probably deserves further attention and specific assessment in order to optimize VTE prophylaxis and treatment.

Keywords

Infection Immobility Venous thromboembolism Pneumonia 

Abbreviation

DVT

Deep vein thrombosis

PE

Pulmonary embolism

VTE

Venous thromboembolism

RIETE

Registro Informatizado de la Enfermedad TromboEmbolica

Helical CT scan

Helical computerized tomography scan

SD

Standard deviation

VKA

Vitamin K antagonist

LMWH

Low molecular weight heparin

IU

International unit

COPD

Chronic obstructive pulmonary disease

NS

Not significant

Notes

Acknowledgments

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 19.76 % of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S & H Medical Science Service, for their quality control, logistic and administrative support and Prof. Salvador Ortiz, Universidad Autónoma de Madrid and Statistical Advisor S & H Medical Science Service for the statistical analysis of the data presented in this paper.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

RIETE registry is realized in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent has been obtained from each enrolled patient.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Stefania Frasson
    • 1
  • Gualberto Gussoni
    • 1
  • Pierpaolo Di Micco
    • 2
  • Raquel Barba
    • 3
  • Laurent Bertoletti
    • 4
  • Manuel J. Nuñez
    • 5
  • Beatriz Valero
    • 6
  • Angel Luis Samperiz
    • 7
  • Agustina Rivas
    • 8
  • Manuel Monreal
    • 9
  • The RIETE Investigators
  1. 1.Department of Clinical ResearchFADOI FoundationMilanItaly
  2. 2.Emergency Room, Department of Internal MedicineFatebenefratelli Hospital of NaplesNaplesItaly
  3. 3.Department of Internal MedicineHospital Rey Juan CarlosMóstolesSpain
  4. 4.Department of Medicine and Therapeutic, Hôpital NordUniversity Hospital of Saint-EtienneSaint-ÉtienneFrance
  5. 5.Department of Internal MedicineComplejo Hospitalario de PontevedraPontevedraSpain
  6. 6.Department of Internal MedicineHospital General Universitario de AlicanteAlicanteSpain
  7. 7.Department of Internal MedicineHospital Reina Sofía de TudelaTudelaSpain
  8. 8.Department of PneumologyHospital TxagorritxuVitoria-GasteizSpain
  9. 9.Department of Internal MedicineHospital Universitari Germans Trias I PujolBadalonaSpain

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