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Risk for pulmonary embolism high after hospitalization for autoimmune disorders
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Patients with autoimmune disorders appear to have a high risk for pulmonary embolism within 1 year after hospitalization for their autoimmune disorder, according to results of a recent study.
“Our results show that autoimmune disorders affect the risk [for] hospital admission for pulmonary embolism in men and women of all ages,” researchers from Sweden wrote in the study.
Analysis focused on more than 500,000 patients in Sweden who were admitted to the hospital for venous thromboembolism with a primary or secondary diagnosis of autoimmune disorder. The study focused on the time period of January 1964 to December 2008. Researchers based diagnosis of pulmonary embolism on WHO International Classification of Diseases.
Researchers identified 33 types of autoimmune disorders. The most common disorders were rheumatoid arthritis, Hashimoto’s thyroiditis and Graves’ disease; others included psoriasis, chronic rheumatic heart disease and Crohn’s disease.
Risk for pulmonary embolism in the first year after hospital admission was 6.38 (95% CI, 6.19-6.57). “All the 33 autoimmune disorders [studied] were associated with a significantly increased risk [for] pulmonary embolism during the first year after admission,” according to the researchers. Patients with some disorders were at particularly high risk, including those with immune thrombocytopenic purpura (standardized incidence ratio [SIR]=10.79; 95% CI, 7.98-14.28), polyarteritis nodosa (SIR=13.26; 95% CI, 9.33-18.29) and polymyositis or dermatomyositis (SIR=16.44; 95% CI, 11.57-22.69).
However, the risk for pulmonary embolism generally decreased after the first year of hospitalization, from 1.53 (95% CI, 1.48-1.57) at 1 to 5 years, to 1.15 (95% CI, 1.11-1.20) at 5 to 10 years, and 1.04 (95% CI, 1.00-1.07) after 10 years.
Men, women and all age groups were at increased risk at different follow-up intervals, with a risk of about six times higher during the first year after hospitalization compared with patients without autoimmune disorders. Finally, researchers found no significant difference between patients who stayed in the hospital for less than 7 days (SIR=1.56; 95% CI, 1.52-1.59) vs. 7 days or more (SIR=1.61; 95% CI, 1.58-1.65).
“Our findings show that autoimmune disorders in general should be regarded not only as inflammatory disorders, but also as hypercoagulable disorders,” the researchers wrote.
“The decrease in overall risk of pulmonary embolism over time for all 33 autoimmune diseases suggests that the decrease in inflammation could be due to reductions in inflammatory activity and treatment,” Carani B. Sanjeevi, MD, MSc, PhD, of the department of medicine at the Karolinska Institutet in Stockholm, Sweden, said in an accompanying editorial. “Anti-inflammatory drugs and thromboprophylaxis should be considered to treat inflammation associated with autoimmune disorders, particularly in people admitted to hospital.”
However, both Sanjeevi and the researchers said further studies are needed to examine this association and identify the predictive value of inflammatory markers for pulmonary embolism.
For more information:
- Sanjeevi CB. Lancet. 2011;doi:10.1016/S0140-6736(11)61510-9.
- Zöller B. Lancet. 2011;doi:10.1016/S0140-6736(11)61306-8.
Disclosure: The researchers report no relevant financial disclosures.
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