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Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study

Daniel Segna, Marie Méan, Andreas Limacher, Christine Baumgartner, Manuel R Blum, Jürg-Hans Beer, Nils Kucher, Marc Righini, Christian M Matter, Beat Frauchiger, Jacques Cornuz, Markus Aschwanden, Martin Banyai, Joseph Osterwalder, Marc Husmann, Michael Egloff, Daniel Staub, Bernhard Lämmle, Anne Angelillo-Scherrer, Drahomir Aujesky & Nicolas Rodondi

abstract

BACKGROUND
Venous thromboembolism (VTE) and subclinical thyroid dysfunction (SCTD) are both common in elderly patients. SCTD has been related to a hypercoagulable state and increased thromboembolic risk. However, prospective data on the relationship between SCTD and VTE are lacking.

OBJECTIVES
To investigate the relationship between SCTD and recurrent VTE (rVTE), all-cause mortality, and thrombophilic biomarkers.

PATIENTS
Elderly participants with VTE.

METHODS
In a prospective multicenter cohort, thyroid hormones and thrombophilic biomarkers were measured 1 year after acute VTE, as both may be influenced by acute thrombosis. We defined subclinical hypothyroidism (SHypo) as elevated thyroid stimulating hormone levels (TSH=4.50-19.99 mIU/l), and subclinical hyperthyroidism (SHyper) as TSH<0.45, both with normal free thyroxine levels. Outcomes were incidence of rVTE and overall mortality during follow-up starting after the 1-year blood sampling.

RESULTS
Of 561 participants (58% with anticoagulation), 6% had SHypo and 5% SHyper. After 20.8 months of mean follow-up, 9% developed rVTE and 10% died. rVTE incidence rate was 7.2 (95% confidence interval:2.7-19.2) per 100 patient-years in SHypo, 0.0 (0.0-7.6) in SHyper and 5.9 (4.4-7.8) in euthyroid participants. In multivariate analyses, the sub-hazard ratio [SHR] for rVTE was 0.00 (0.00-0.58) in SHyper and 1.50 (0.52-4.34) in SHypo compared to euthyroids, without increased thrombophilic biomarkers. SHyper (HR 0.80,0.23-2.81) and SHypo (HR 0.99,0.30-3.29) were not associated with mortality.

CONCLUSION
In elderly patients, SHyper may be associated with lower rVTE risks. SHypo showed a non-statistically significant pattern of an association with rVTE, without increased mortality or differences in thrombophilic biomarkers. This article is protected by copyright. All rights reserved.
   
citation Segna D, Méan M, Limacher A, Baumgartner C, Blum M R, Beer J H, Kucher N, Righini M, Matter C M, Frauchiger B, Cornuz J, Aschwanden M, Banyai M, Osterwalder J, Husmann M, Egloff M, Staub D, Lämmle B, Angelillo-Scherrer A, Aujesky D, Rodondi N. Association between thyroid dysfunction and venous thromboembolism in the elderly: a prospective cohort study. J Thromb Haemost 2016;.
   
type journal paper/review (English)
date of publishing 27-1-2016
journal title J Thromb Haemost
ISSN electronic 1538-7836
PubMed 26816339
DOI 10.1111/jth.13276