Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides.
Venous thromboembolism (VTE) is a prevalent multifactorial health condition associated with significant morbidity and mortality. Population-based epidemiological studies have revealed an association between systemic autoimmune diseases and deep venous thrombosis (DVT)/VTE. The etiopathogenesis of increased risk of VTE in systemic autoimmune diseases is not entirely clear but multiple contributors have been explored, especially in the context of systemic inflammation and disordered thrombogenesis. Epidemiologic data on increased risk of VTE in patients with primary systemic vasculitides (PSV) have accumulated in recent years and some of these studies suggest the increased risk while patients have active diseases. This could lead us to hypothesize that venous vascular inflammation has a role to play in this phenomenon, but this is unproven. The role of immunosuppressive agents in modulating the risk of VTE in patients with PSV is not yet clear except for Behçet's disease, where most of the studies are retrospective. Sensitizing physicians to this complication has implications for prevention and optimal management of patients with these complex diseases. This review will focus on the epidemiology and available evidence regarding pathogenesis, and will attempt to summarize the best available data regarding evaluation and treatment of these patients.
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, USA tamakih@ccf.org.
Hiromichi
H
Tamaki
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, USA.
Atul
A
Khasnis
D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D018836:Inflammation Mediators / Q000276:immunology; D015995:Prevalence; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D015398:Signal Transduction; D056647:Systemic Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control
D007166:Immunosuppressive Agents; D018836:Inflammation Mediators
deep vein thrombosis; primary systemic vasculitis; pulmonary embolism; venous thromboembolism