Risk of future arterial cardiovascular events in patients with idiopathic venous thromboembolism.
Venous and arterial thromboses have traditionally been considered distinct pathophysiologic entities. However, the two disorders have many features in common, and there is evidence that persons with venous thrombosis may be at greater risk for arterial events. The pathogenesis of both disorders includes endothelial injury, platelet activation, elevated levels of intrinsic clotting factors and inflammatory markers, increased fibrinogen, and impaired fibrinolysis. In addition, older age, obesity, dyslipidemia, and smoking predispose to both venous and arterial thrombosis. While the evidence that arterial disease is a risk factor for venous thrombosis is inconclusive, arterial disease does appear to occur with a modestly increased frequency in patients with a history of venous thromboembolism. Reported odds ratios in such patients were 1.2 for myocardial infarction, 1.3 for stroke, 2.3 for carotid plaque, and 4.3 for coronary calcification. Of note, in persons under age 40 with unprovoked venous thrombosis, the odds ratio for acute myocardial infarction was as high as 3.9. In general, however, venous disease is considered to be a weak risk factor for arterial thrombosis, and the use of agents specifically targeted to the prevention of heart attack or stroke in the majority of persons with VTE cannot be recommended at present.
Green
David
D
Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. d-green@northwestern.edu
D000328:Adult; D000367:Age Factors; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000453:epidemiology*; D001779:Blood Coagulation Factors / Q000032:analysis; D002340:Carotid Artery Diseases / Q000097:blood / Q000453:epidemiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D019851:Thrombophilia / Q000097:blood / Q000453:epidemiology*; D019564:Unnecessary Procedures; D054556:Venous Thromboembolism / Q000097:blood / Q000453:epidemiology*
D001779:Blood Coagulation Factors; D005343:Fibrinolytic Agents