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Research ArticleArticle

Venous Thromboembolism in Systemic Sclerosis: Prevalence, Risk Factors, and Effect on Survival

Sindhu R. Johnson, Nabil Hakami, Zareen Ahmad and Duminda N. Wijeysundera
The Journal of Rheumatology April 2018, jrheum.170268; DOI: https://doi.org/10.3899/jrheum.170268
Sindhu R. Johnson
From the Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital; Division of Rheumatology, Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation; Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; King Fahad Central Hospital, Ministry of Health, Jizan, Saudi Arabia. Dr. Johnson is supported by a Canadian Institutes of Health Research Clinician Scientist Award, the Oscar and Eleanor Markovitz Fund for Scleroderma Research, and the Freda Fejer Fund of the Arthritis Research Foundation. Dr. Wijeysundera is supported in part by a New Investigator Award from the Canadian Institutes of Health Research and a Merit Award from the Department of Anesthesia at the University of Toronto. S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto; N. Hakami, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and King Fahad Central Hospital, Ministry of Health; Z. Ahmad, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Division of Rheumatology, Department of Medicine, University of Toronto; D.N. Wijeysundera, MD, PhD, Department of Anesthesia and Pain Management, Toronto General Hospital, and Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto. Address correspondence to Dr. S. Johnson, Division of Rheumatology, Ground Floor, East Wing, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: Sindhu.Johnson@uhn.ca. Accepted for publication December 14, 2017.
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Nabil Hakami
From the Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital; Division of Rheumatology, Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation; Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; King Fahad Central Hospital, Ministry of Health, Jizan, Saudi Arabia. Dr. Johnson is supported by a Canadian Institutes of Health Research Clinician Scientist Award, the Oscar and Eleanor Markovitz Fund for Scleroderma Research, and the Freda Fejer Fund of the Arthritis Research Foundation. Dr. Wijeysundera is supported in part by a New Investigator Award from the Canadian Institutes of Health Research and a Merit Award from the Department of Anesthesia at the University of Toronto. S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto; N. Hakami, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and King Fahad Central Hospital, Ministry of Health; Z. Ahmad, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Division of Rheumatology, Department of Medicine, University of Toronto; D.N. Wijeysundera, MD, PhD, Department of Anesthesia and Pain Management, Toronto General Hospital, and Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto. Address correspondence to Dr. S. Johnson, Division of Rheumatology, Ground Floor, East Wing, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: Sindhu.Johnson@uhn.ca. Accepted for publication December 14, 2017.
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Zareen Ahmad
From the Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital; Division of Rheumatology, Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation; Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; King Fahad Central Hospital, Ministry of Health, Jizan, Saudi Arabia. Dr. Johnson is supported by a Canadian Institutes of Health Research Clinician Scientist Award, the Oscar and Eleanor Markovitz Fund for Scleroderma Research, and the Freda Fejer Fund of the Arthritis Research Foundation. Dr. Wijeysundera is supported in part by a New Investigator Award from the Canadian Institutes of Health Research and a Merit Award from the Department of Anesthesia at the University of Toronto. S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto; N. Hakami, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and King Fahad Central Hospital, Ministry of Health; Z. Ahmad, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Division of Rheumatology, Department of Medicine, University of Toronto; D.N. Wijeysundera, MD, PhD, Department of Anesthesia and Pain Management, Toronto General Hospital, and Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto. Address correspondence to Dr. S. Johnson, Division of Rheumatology, Ground Floor, East Wing, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: Sindhu.Johnson@uhn.ca. Accepted for publication December 14, 2017.
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Duminda N. Wijeysundera
From the Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital; Division of Rheumatology, Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation; Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; King Fahad Central Hospital, Ministry of Health, Jizan, Saudi Arabia. Dr. Johnson is supported by a Canadian Institutes of Health Research Clinician Scientist Award, the Oscar and Eleanor Markovitz Fund for Scleroderma Research, and the Freda Fejer Fund of the Arthritis Research Foundation. Dr. Wijeysundera is supported in part by a New Investigator Award from the Canadian Institutes of Health Research and a Merit Award from the Department of Anesthesia at the University of Toronto. S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto; N. Hakami, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, and King Fahad Central Hospital, Ministry of Health; Z. Ahmad, MD, Toronto Scleroderma Program, Mount Sinai Hospital, Division of Rheumatology, Department of Medicine, University of Toronto; D.N. Wijeysundera, MD, PhD, Department of Anesthesia and Pain Management, Toronto General Hospital, and Department of Anesthesia and Institute of Health Policy, Management and Evaluation, University of Toronto. Address correspondence to Dr. S. Johnson, Division of Rheumatology, Ground Floor, East Wing, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: Sindhu.Johnson@uhn.ca. Accepted for publication December 14, 2017.
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Abstract

Objective Whether systemic sclerosis (SSc) confers increased risk of venous thromboembolism (VTE) is uncertain. We evaluated the prevalence, risk factors, and effect of VTE on SSc survival.

Methods A cohort study was conducted of subjects with SSc who fulfilled the American College of Rheumatology/European League Against Rheumatism classification criteria between 1970 and 2017. Deep vein thrombosis was defined as thrombus on extremity ultrasound. Pulmonary embolism was defined as thrombus on thorax computed tomography angiogram. Risk factors for VTE and time to all-cause mortality were evaluated.

Results Of the 1181 subjects, 40 (3.4%) experienced VTE events. The cumulative incidence of VTE was 2.7 (95% CI 1.9–3.7) per 1000 patient-years. Pulmonary arterial hypertension (PAH; OR 3.77, 95% CI 1.83–8.17), peripheral arterial disease (OR 5.31, 95% CI 1.99–12.92), Scl-70 (OR 2.45, 95% CI 1.07–5.30), and anticardiolipin antibodies (OR 5.70, 95% CI 1.16–21.17) were predictors of VTE. There were 440 deaths. There was no difference in survival between those with and without VTE (HR 1.16, 95% CI 0.70–1.91). Interstitial lung disease (HR 1.54, 95% CI 1.27–1.88) and PAH (HR 1.35, 95% CI 1.10–1.65) were predictors of mortality.

Conclusion The risk of VTE in SSc is comparable to the general population. The presence of PAH, peripheral arterial disease, Scl-70, and anticardiolipin antibodies are risk factors for VTE. VTE does not independently predict SSc survival.

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The Journal of Rheumatology: 45 (4)
The Journal of Rheumatology
Vol. 45, Issue 4
1 Apr 2018
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Venous Thromboembolism in Systemic Sclerosis: Prevalence, Risk Factors, and Effect on Survival
Sindhu R. Johnson, Nabil Hakami, Zareen Ahmad, Duminda N. Wijeysundera
The Journal of Rheumatology Apr 2018, jrheum.170268; DOI: 10.3899/jrheum.170268

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Venous Thromboembolism in Systemic Sclerosis: Prevalence, Risk Factors, and Effect on Survival
Sindhu R. Johnson, Nabil Hakami, Zareen Ahmad, Duminda N. Wijeysundera
The Journal of Rheumatology Apr 2018, jrheum.170268; DOI: 10.3899/jrheum.170268
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