Patients With Rheumatoid Arthritis Have Higher Risk of VTE, DVT, PE

Patients with rheumatoid arthritis (RA) have a higher risk of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) compared with the general population, according to a study published in BMC Rheumatology.

Led by Zahra Fazal and Ana Michelle Avina-Galindo, of Arthritis Research Canada, the meta-analysis included 14 studies identified through the MEDLINE and EMBASE databases. Collectively, the studies evaluated 602,760 patients with RA who had 123,076 VTE events.

Patients with RA had a 57% increased risk of VTE; a 58% increased risk of DVT; and a 57% increased risk of PE. The pooled risk ratios of VTE, DVT, and PE were 1.57 (95% CI 1.41-1.76), 1.58 (95% CI 1.26-1.97) and 1.57 (95% CI 1.30-1.88), respectively. The I² values were 92%, 94%, and 92% for VTE, DVT, and PE analyses, respectively.

To investigate potential causes of heterogeneity, the researchers conducted subgroup analyses by quality score for the individual studies, sex of patients, year of study, population source, and study design. The increased risk of VTE for patients with RA remained significant even when stratified by these variables, according to the researchers.

The analysis also found that VTE risk is greatest in the first year after RA diagnosis, then subsequently decreases. Other VTE risk factors among patients with RA include smoking, obesity, major surgery, hospitalization with immobilization, and RA therapies such as cyclooxygenase-2 inhibitors and glucocorticoids.

“Given the increased risk of VTE, including DVT and PE, among patients with RA, strategies for the primary prevention of VTE are suggested,” the researchers wrote.

Some prevention strategies highlighted in the study include additional patient monitoring by health care providers, especially after diagnosis or surgery; increased awareness of VTE risk through clinician-patient communication; and further research for biomarkers related to increased risk, VTE identification strategies, and improved treatments.

Reference

Fazal ZA, Avina-Galindo AM, Marozoff S, et al. Risk of venous thromboembolism in patients with rheumatoid arthritis: a meta-analysis of observational studies. BMC Rheumatol. 2024. doi.org/10.1186/s41927-024-00376-9