title: Antibiotic use as a marker of acute infection and risk of first and recurrent venous thrombosis.
abstract: A role for transient infections in the aetiology of venous thrombosis (VT) has been suggested. This study aimed to determine whether individuals who receive antibiotic treatment (as a proxy for infections) have an increased risk of first and recurrent VT and whether infections should be seen as a provoking risk factor for VT. We used the self-controlled case series method to study the risk of first VT during antibiotic prescriptions. The risk of recurrent VT during antibiotic use was estimated by of time-dependent Cox-regression. A total of 2547 patients with a first VT were included and followed for a median of 5·9 years for recurrence (1999-2010), in whom 114 first events occurred during antibiotic use. We found a five-fold increased risk of first VT during antibiotic treatment: [incidence-rate-ratio 5·0; 95% confidence interval (CI), 4·0-6·1]. Antibiotic use was associated with a 2·0-fold (95% CI, 1·1-4·0) increased risk of recurrent VT. Patients with an unprovoked first VT who used antibiotics shortly before this event, had a similar risk of recurrence as patients with a provoked first VT (adjusted hazard ratio 1·1; 95% CI, 0·7-1·7). Individuals who receive antibiotics have an increased risk of first and recurrent VT and infections should be considered a provoking risk factor for VT.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Jasmijn F
authors.initials: JF
authors.lastname: Timp
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.|Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, the Netherlands.|Department of Internal Medicine, Section Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Cannegieter
authors.affiliation: Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands.|K.G. Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tichelaar
authors.affiliation: K.G. Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
authors.forename: Sigrid K
authors.initials: SK
authors.lastname: Braekkan
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.|Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.|Department of Medical Statistics, Leiden University Medical Centre, the Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.|Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Willem M
authors.initials: WM
authors.lastname: Lijfering
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers
keywords: antibiotics; epidemiology; infection; recurrence; venous thrombosis