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Risk of venous thromboembolism in patients with rheumatoid arthritis: a systematic review and meta-analysis

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We performed this meta-analysis to assess venous thromboembolism risk in patients with rheumatoid arthritis. A comprehensive search was performed in MEDLINE, EMBASE, and the Cochrane databases. Nine observational studies met our inclusion criteria and were included in the data analysis. The pooled risk ratios of deep venous thrombosis, pulmonary embolism, and venous thromboembolism in patients with rheumatoid arthritis (RA) compared with non-RA participants were 2.08 (95 % CI 1.75–2.47), 2.17 (95 % CI 2.05–2.31), and 1.96 (95 % CI 1.81–2.11), respectively. Subgroup analysis demonstrated a consistent increased risk in every study design (cohort, case–control, and cross-sectional). Our results indicate a significant increased risk of venous thromboembolism among patients with rheumatoid arthritis.

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  1. Naess IA, Christiansen SC, Romundstad P et al (2007) Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 5:692–699

    Article  CAS  PubMed  Google Scholar 

  2. Cushman M, Tsai AW, White RH et al (2004) Deep venous thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 117:19–25

    Article  PubMed  Google Scholar 

  3. Heit JA, Silverstein MD, Mohr DN et al (1999) Predictor of survival after deep venous thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med 159:445–453

    Article  CAS  PubMed  Google Scholar 

  4. Xu J, Lupu F, Esmon CT (2010) Inflammation, innate immunity and blood coagulation. Hamostaseologie 30(5–6):8–9

    Google Scholar 

  5. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605

    Article  PubMed  Google Scholar 

  6. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed Central  PubMed  Google Scholar 

  7. Kang JH, Keller JJ, Lin YK, Lin HC (2012) A population-based case–control study on association between rheumatoid arthritis and deep vein thrombosis. J Vasc Surg 56:1642–1648

    Article  PubMed  Google Scholar 

  8. Johannesdottir SA, Schmidt M, Horvath-Puho E, Sorensen HT (2012) Autoimmune skin and connective tissue diseases and risk of venous thromboembolism: a population-based case–control study. J Thromb Haemost 10:815–821

    Article  CAS  PubMed  Google Scholar 

  9. Ocak G, Vossen CY, Verduijn M et al (2013) Risk of venous thrombosis in patients with major illnesses: result from the MEGA study. J Thromb Haemost 11:116–123

    Article  CAS  PubMed  Google Scholar 

  10. Matta F, Singala R, Yaekoub AY, Najjar R, Stein PD (2009) Risk of venous thromboembolism with rheumatoid arthritis. Thromb Haemost 101:134–138

    CAS  PubMed  Google Scholar 

  11. Bacani AK, Gabriel SE, Crowson CS, Heit JA, Matteson EL (2012) Noncardiac vascular disease in rheumatoid arthritis. Arthritis Rheum 64:53–61

    Article  PubMed Central  PubMed  Google Scholar 

  12. Holmqvist ME, Neovius M, Eriksson J et al (2012) Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization. JAMA 308:1350–1356

    Article  CAS  PubMed  Google Scholar 

  13. Choi HK, Rho YH, Zhu Y, Cea-Soriano LC, Avina-Zubieta JA, Zhang Y (2013) The risk of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a UK population-based outpatient cohort study. Ann Rheum Dis 72:1182–1187

    Article  PubMed  Google Scholar 

  14. Chung WS, Peng CL, Lin CL et al (2013) Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Ann Rheum Dis August 13

  15. Kim SC, Schneeweiss S, Liu J, Solomom DH (2013) Risk of venous thromboembolism in patients with rheumatoid arthritis. Arthritis Care Res 65:1600–1607

    Google Scholar 

  16. Montecucco F, Mach F (2009) Common inflammatory mediators orchestrate pathophysiological processes in rheumatoid arthritis and atherosclerosis. Rheumatology (Oxford) 48:11–22

    Article  CAS  Google Scholar 

  17. Conway EM, Rosenberg RD (1988) Tumor necrosis factor suppresses transcription of the thrombomodulin gene in endothelial cells. Mol Cell Biol 8:5588–5592

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Hansen S, Lassig G, Pistrosch E, Passauer J (2003) Endothelial dysfunction in young patients with long-term rheumatoid arthritis and low disease activity. Atherosclerosis 170:177–180

    Article  Google Scholar 

  19. McLaughlin GE (2002) Sudden death in rheumatoid arthritis: pulmonary embolism—a fatal complication of iliopsoas bursitis. J Clin Rheumatol 8:208–211

    Article  PubMed  Google Scholar 

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Correspondence to Patompong Ungprasert.

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Ungprasert, P., Srivali, N., Spanuchart, I. et al. Risk of venous thromboembolism in patients with rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol 33, 297–304 (2014).

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