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Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis

OBJECTIVE: To determine whether sickle cell carriers (‘sickle cell trait’) have an increased risk of venous thromboembolism (VTE). DESIGN: Cohort study with nested case–control analysis. SETTING: General population with data from 609 UK general practices in the Clinical Practice Research Datalink (C...

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Autores principales: Little, Iain, Vinogradova, Yana, Orton, Elizabeth, Kai, Joe, Qureshi, Nadeem
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372149/
https://www.ncbi.nlm.nih.gov/pubmed/28360235
http://dx.doi.org/10.1136/bmjopen-2016-012665
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author Little, Iain
Vinogradova, Yana
Orton, Elizabeth
Kai, Joe
Qureshi, Nadeem
author_facet Little, Iain
Vinogradova, Yana
Orton, Elizabeth
Kai, Joe
Qureshi, Nadeem
author_sort Little, Iain
collection PubMed
description OBJECTIVE: To determine whether sickle cell carriers (‘sickle cell trait’) have an increased risk of venous thromboembolism (VTE). DESIGN: Cohort study with nested case–control analysis. SETTING: General population with data from 609 UK general practices in the Clinical Practice Research Datalink (CPRD). PARTICIPANTS: All individuals registered with a CPRD general practice between 1998 and 2013, with a medical record of screening for sickle cell between 18 and 75 years of age. MAIN OUTCOMES MEASURES: Incidence of VTE per 10 000 person-years (PY) among sickle cell carriers and non-carriers; and adjusted OR for VTE among sickle cell carriers compared with non-carriers. RESULTS: We included 30 424 individuals screened for sickle cell, with a follow-up time of 179 503 PY, identifying 55 VTEs in 6758 sickle cell carriers and 125 VTEs in 23 666 non-carriers. VTE incidence among sickle cell carriers (14.9/10 000 PY; 95% CI 11.4 to 19.4) was significantly higher than non-carriers (8.8/10 000 PY; 95% CI 7.4 to 10.4). Restricting analysis to confirmed non-carriers was non-significant, but performed on a small sample. In the case–control analysis (180 cases matched to 1775 controls by age and gender), sickle cell carriers remained at increased risk of VTE after adjusting for body mass index, pregnancy, smoking status and ethnicity (OR 1.78, 95% CI 1.18 to 2.69, p=0.006), with the greatest risk for pulmonary embolism (PE) (OR 2.27, 95% CI 1.17 to 4.39, p=0.011). CONCLUSIONS: Although absolute numbers are small, in a general population screened for sickle cell, carriers have a higher incidence and risk of VTE, particularly PE, than non-carriers. Clinicians should be aware of this elevated risk in the clinical care of sickle cell carriers, or when discussing carrier screening, and explicitly attend to modifiable risk factors for VTE in these individuals. More complete primary care coding of carrier status could improve analysis.
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spelling pubmed-53721492017-04-12 Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis Little, Iain Vinogradova, Yana Orton, Elizabeth Kai, Joe Qureshi, Nadeem BMJ Open Genetics and Genomics OBJECTIVE: To determine whether sickle cell carriers (‘sickle cell trait’) have an increased risk of venous thromboembolism (VTE). DESIGN: Cohort study with nested case–control analysis. SETTING: General population with data from 609 UK general practices in the Clinical Practice Research Datalink (CPRD). PARTICIPANTS: All individuals registered with a CPRD general practice between 1998 and 2013, with a medical record of screening for sickle cell between 18 and 75 years of age. MAIN OUTCOMES MEASURES: Incidence of VTE per 10 000 person-years (PY) among sickle cell carriers and non-carriers; and adjusted OR for VTE among sickle cell carriers compared with non-carriers. RESULTS: We included 30 424 individuals screened for sickle cell, with a follow-up time of 179 503 PY, identifying 55 VTEs in 6758 sickle cell carriers and 125 VTEs in 23 666 non-carriers. VTE incidence among sickle cell carriers (14.9/10 000 PY; 95% CI 11.4 to 19.4) was significantly higher than non-carriers (8.8/10 000 PY; 95% CI 7.4 to 10.4). Restricting analysis to confirmed non-carriers was non-significant, but performed on a small sample. In the case–control analysis (180 cases matched to 1775 controls by age and gender), sickle cell carriers remained at increased risk of VTE after adjusting for body mass index, pregnancy, smoking status and ethnicity (OR 1.78, 95% CI 1.18 to 2.69, p=0.006), with the greatest risk for pulmonary embolism (PE) (OR 2.27, 95% CI 1.17 to 4.39, p=0.011). CONCLUSIONS: Although absolute numbers are small, in a general population screened for sickle cell, carriers have a higher incidence and risk of VTE, particularly PE, than non-carriers. Clinicians should be aware of this elevated risk in the clinical care of sickle cell carriers, or when discussing carrier screening, and explicitly attend to modifiable risk factors for VTE in these individuals. More complete primary care coding of carrier status could improve analysis. BMJ Publishing Group 2017-03-29 /pmc/articles/PMC5372149/ /pubmed/28360235 http://dx.doi.org/10.1136/bmjopen-2016-012665 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Genetics and Genomics
Little, Iain
Vinogradova, Yana
Orton, Elizabeth
Kai, Joe
Qureshi, Nadeem
Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
title Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
title_full Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
title_fullStr Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
title_full_unstemmed Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
title_short Venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
title_sort venous thromboembolism in adults screened for sickle cell trait: a population-based cohort study with nested case–control analysis
topic Genetics and Genomics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372149/
https://www.ncbi.nlm.nih.gov/pubmed/28360235
http://dx.doi.org/10.1136/bmjopen-2016-012665
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