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Open Access 01-12-2023 | Stroke | Research

The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study

Authors: Changqing Sun, Rongrong Wang, Lianke Wang, Panpan Wang, Ying Qin, Qianyu Zhou, Yuanli Guo, Mingyang Zhao, Wenqian He, Bo Hu, Zihui Yao, Peijia Zhang, Tiantian Wu, Yu Wang, Qiang Zhang

Published in: Thrombosis Journal | Issue 1/2023

Abstract

Background

Blood transfusion and previous stroke history are two independent risk factors of venous thromboembolism (VTE) in stroke patients. Whether the potential interaction of transfusion history and previous stroke history is associated with a greater risk of VTE remains unclear. This study aims to explore whether the combination of transfusion history and previous stroke history increases the risk of VTE among Chinese stroke patients.

Methods

A total of 1525 participants from the prospective Stroke Cohort of Henan Province were enrolled in our study. Multivariate logistic regression models were used to explore the associations among transfusion history, previous stroke history and VTE. The interaction was evaluated on both multiplicative and additive scales. The odds ratio (95% CI), relative excess risk of interaction (RERI), attributable proportion (AP), and synergy index (S) of interaction terms were used to examine multiplicative and additive interactions. Finally, we divided our population into two subgroups by National Institutes of Health Stroke Scale (NIHSS) score and re-evaluated the interaction effect in both scales.

Results

A total of 281 (18.4%) participants of 1525 complicated with VTE. Transfusion and previous stroke history were associated with an increased risk of VTE in our cohort. In the multiplicative scale, the combination of transfusion and previous stroke history was statistically significant on VTE in both unadjusted and adjusted models (P<0.05). For the additive scale, the RERI shrank to 7.016 (95% CI: 1.489 ~ 18.165), with the AP of 0.650 (95% CI: 0.204 ~ 0.797) and the S of 3.529 (95% CI: 1.415 ~ 8.579) after adjusting for covariates, indicating a supra-additive effect. In subgroups, the interaction effect between transfusion history and previous stroke history was pronouncedly associated with the increased risk of VTE in patients with NIHSS score > 5 points (P<0.05).

Conclusions

Our results suggest that there may be a potential synergistic interaction between transfusion history and previous stroke history on the risk of VTE. Besides, the percentage of VTE incidence explained by interaction increased with the severity of stroke. Our findings will provide valuable evidence for thromboprophylaxis in Chinese stroke patients.

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Title: The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study
Authors: Changqing Sun
Rongrong Wang
Lianke Wang
Panpan Wang
Ying Qin
Qianyu Zhou
Yuanli Guo
Mingyang Zhao
Wenqian He
Bo Hu
Zihui Yao
Peijia Zhang
Tiantian Wu
Yu Wang
Qiang Zhang
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Stroke
Published in: Thrombosis Journal / Issue 1/2023
Electronic ISSN: 1477-9560
DOI: https://doi.org/10.1186/s12959-023-00487-2

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