A meta-analysis of the risk of venous thromboembolism in inflammatory rheumatic diseases

Jason J Lee, Janet E Pope

IntroductionWe performed a meta-analysis investigating the risk of developing deep vein thrombosis (DVT) and/or pulmonary embolisms (PE) in patients with inflammatory arthritis, vasculitis, and connective tissue diseases (CTD) (systemic lupus erythematosus (SLE), Sjogren¿s syndrome, inflammatory myositis and systemic sclerosis (SSc)).MethodsPubMed, Embase, Cochrane Databases, and Medline were searched identifying full text English publications in adults related to rheumatologic inflammatory diseases and venous thrombo-embolism (VTE). Data regarding rates of DVTs and PEs were extracted. Using random effects models, pooled estimates for VTE in individual and pooled diseases compared with matched populations where possible. Studies were excluded if VTEs were in the setting of pregnancy, postoperative outcomes or solely antiphospholipid antibody syndrome.ResultsMost of the 5,206 studies were excluded due to lack of rate or incidence of VTE. In total, 25 studies remained for analysis. Ten studies that included RA identified 5,273,942 patients and 891,530,181 controls with a cumulative incidence of 2.18% (95% confidence interval (CI): 1.82 to 2.54%) and an odds ratio of 2.23 (95% CI: 2.02 to 2.47) compared to age and sex, matched population. Ten studies observed 54,697 SLE patients with a cumulative incidence of 7.29% (95% CI: 5.82 to 8.75%); four Sjogren¿s syndrome studies (N¿=¿25,100) demonstrated a VTE cumulative incidence of 2.18% (95% CI: 0.79 to 3.57%); four studies of inflammatory myositis (N¿=¿8,245) yielded a VTE cumulative incidence of 4.03% (95% CI: 2.38 to 5.67%), SSc and anti-neutrophil cytoplasmic antibody vasculitis rates (4 studies each) were 3.13% and 7.97% respectively.ConclusionsInflammatory rheumatologic diseases studied were all associated with high rates of VTEs, more than three times higher than the general population.