Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Rheumatology Reports
Published in: Current Rheumatology Reports 2/2015

01-02-2015 | Surgery and Perioperative Care (CR MacKenzie and SM Goodman, Section Editors)

Postoperative Risk of Venous Thromboembolism in Rheumatic Disease Patients

Authors: Lauren E. Wong, Anne R. Bass

Published in: Current Rheumatology Reports | Issue 2/2015

Login to get access

Abstract

Both traditional and disease-related risk factors for venous thromboembolism (VTE) must be considered when assessing rheumatic disease patients preoperatively. While many studies suggest that patients with rheumatic diseases are at higher risk of VTE overall, studies in rheumatoid arthritis patients do not demonstrate an increased risk of postoperative VTE. Here, we review the literature on VTE risk in patients with rheumatoid arthritis, systemic lupus erythematosus, Behcet’s disease, and vasculitis. The data suggest that disease activity is a driver of VTE risk. While rheumatoid arthritis patients undergoing elective arthroplasty are not at elevated VTE risk, patients with systemic lupus erythematosus and antiphospholipid antibody syndrome undergoing surgery have an elevated risk of postoperative VTE.
Literature
1.
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S–325.PubMedCentralPubMed
2.
Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S–77. PMCID: PMC3278061.PubMedCentralPubMed
3.
Pannucci CJ, Bailey SH, Dreszer G, Fisher Wachtman C, Zumsteg JW, Jaber RM, et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg. 2011;212(1):105–12.CrossRefPubMedCentralPubMed
4.
White RH, Zhou H, Gage BF. Effect of age on the incidence of venous thromboembolism after major surgery. J Thromb Haemost. 2004;2(8):1327–33.CrossRefPubMed
5.
Memtsoudis SG, Gonzalez Della Valle A, Besculides MC, Gaber L, Sculco TP. In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res. 2008;466(11):2617–27. PMCID: PMC2565056.CrossRefPubMedCentralPubMed
6.
Imberti D, Bianchi C, Zambon A, Parodi A, Merlino L, Gallerani M, et al. Venous thromboembolism after major orthopaedic surgery: a population-based cohort study. Intern Emerg Med. 2012;7(3):243–9.CrossRefPubMed
7.
Grady D, Wenger NK, Herrington D, Khan S, Furberg C, Hunninghake D, et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med. 2000;132(9):689–96.CrossRefPubMed
8.
Kapoor A, Labonte AJ, Winter MR, Segal JB, Silliman RA, Katz JN, et al. Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the nationwide inpatient sample (2003–2006). BMC Geriatr. 2010;10:63. PMCID: PMC2949673.CrossRefPubMedCentralPubMed
9.
Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112(1):113–21.CrossRefPubMed
10.•
Ramagopalan SV, Wotton CJ, Handel AE, Yeates D, Goldacre MJ. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study. BMC Med. 2011;9:1-7015-9-1. PMCID: PMC3025873. This was a record-linkage study using hospital admissions data from the United Kingdom that demonstrated an increased risk of VTE in several autoimmune conditions.
11.
Zoller B, Li X, Sundquist J, Sundquist K. Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet. 2012;379(9812):244–9.CrossRefPubMed
12.
Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973–9.CrossRefPubMed
13.
Folsom AR, Lutsey PL, Astor BC, Cushman M. C-reactive protein and venous thromboembolism. A prospective investigation in the ARIC cohort. Thromb Haemost. 2009;102(4):615–9. PMCID: PMC2810122.PubMedCentralPubMed
14.
Kamphuisen PW, Eikenboom JC, Vos HL, Pablo R, Sturk A, Bertina RM, et al. Increased levels of factor VIII and fibrinogen in patients with venous thrombosis are not caused by acute phase reactions. Thromb Haemost. 1999;81(5):680–3.PubMed
15.
Zacho J, Tybjaerg-Hansen A, Nordestgaard BG. C-reactive protein and risk of venous thromboembolism in the general population. Arterioscler Thromb Vasc Biol. 2010;30(8):1672–8.CrossRefPubMed
16.
Vormittag R, Vukovich T, Schonauer V, Lehr S, Minar E, Bialonczyk C, et al. Basal high-sensitivity-C-reactive protein levels in patients with spontaneous venous thromboembolism. Thromb Haemost. 2005;93(3):488–93.PubMed
17.
Loof TG, Schmidt O, Herwald H, Theopold U. Coagulation systems of invertebrates and vertebrates and their roles in innate immunity: the same side of two coins? J Innate Immun. 2011;3(1):34–40.CrossRefPubMed
18.
Engelmann B, Massberg S. Thrombosis as an intravascular effector of innate immunity. Nat Rev Immunol. 2013;13(1):34–45.CrossRefPubMed
19.
20.
von Bruhl ML, Stark K, Steinhart A, Chandraratne S, Konrad I, Lorenz M, et al. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med. 2012;209(4):819–35. PMCID: PMC3328366.CrossRef
21.
22.
Dessein PH, Solomon A, Woodiwiss AJ, Norton GR, Tsang L, Gonzalez-Gay MA. Marked independent relationship between circulating interleukin-6 concentrations and endothelial activation in rheumatoid arthritis. Mediat Inflamm. 2013;2013:510243. PMCID: PMC3880757.
23.
Wakefield TW, Myers DD, Henke PK. Mechanisms of venous thrombosis and resolution. Arterioscler Thromb Vasc Biol. 2008;28(3):387–91.CrossRefPubMed
24.
Zoller B, Li X, Sundquist J, Sundquist K. Autoimmune diseases and venous thromboembolism: a review of the literature. Am J Cardiovasc Dis. 2012;2(3):171–83. PMCID: PMC3427982.PubMedCentralPubMed
25.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010;375(9715):657–63.CrossRefPubMed
26.
Lee JJ, Pope JE. A meta-analysis of the risk of venous thromboembolism in inflammatory rheumatic diseases. Arthritis Res Ther. 2014;16(5):435. PMCID: PMC4207310.CrossRefPubMedCentralPubMed
27.
Yusuf HR, Hooper WC, Grosse SD, Parker CS, Boulet SL, Ortel TL. Risk of venous thromboembolism occurrence among adults with selected autoimmune diseases: a study among a U.S. cohort of commercial insurance enrollees. Thromb Res. 2014.
28.
Kim SC, Schneeweiss S, Liu J, Solomon DH. Risk of venous thromboembolism in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013;65(10):1600–7.
29.
Bacani AK, Gabriel SE, Crowson CS, Heit JA, Matteson EL. Noncardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? Arthritis Rheum. 2012;64(1):53–61. PMCID: PMC3474372.CrossRefPubMedCentralPubMed
30.
Matta F, Singala R, Yaekoub AY, Najjar R, Stein PD. Risk of venous thromboembolism with rheumatoid arthritis. Thromb Haemost. 2009;101(1):134–8.PubMed
31.
Ungprasert P, Srivali N, Spanuchart I, Thongprayoon C, Knight EL. Risk of venous thromboembolism in patients with rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol. 2014;33(3):297–304.CrossRefPubMed
32.
Niki Y, Matsumoto H, Hakozaki A, Mochizuki T, Momohara S. Rheumatoid arthritis: a risk factor for deep venous thrombosis after total knee arthroplasty? Comparative study with osteoarthritis. J Orthop Sci. 2010;15(1):57–63.CrossRefPubMed
33.
White RH, Gettner S, Newman JM, Trauner KB, Romano PS. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med. 2000;343(24):1758–64.CrossRefPubMed
34.
Pedersen AB, Sorensen HT, Mehnert F, Overgaard S, Johnsen SP. Risk factors for venous thromboembolism in patients undergoing total hip replacement and receiving routine thromboprophylaxis. J Bone Joint Surg Am. 2010;92(12):2156–64.CrossRefPubMed
35.••
Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch E, Kreder H, et al. Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol. 2014;66(2):254–63. This large study of administrative data showed that patients with RA are not at increased risk for VTE following knee or hip arthroplasty compared to those with OA.CrossRefPubMed
36.
Mok CC, Ho LY, Yu KL, To CH. Venous thromboembolism in southern Chinese patients with systemic lupus erythematosus. Clin Rheumatol. 2010;29(6):599–604.CrossRefPubMed
37.
Levy DM, Massicotte MP, Harvey E, Hebert D, Silverman ED. Thromboembolism in paediatric lupus patients. Lupus. 2003;12(10):741–6.CrossRefPubMed
38.
Brouwer JL, Bijl M, Veeger NJ, Kluin-Nelemans HC, van der Meer J. The contribution of inherited and acquired thrombophilic defects, alone or combined with antiphospholipid antibodies, to venous and arterial thromboembolism in patients with systemic lupus erythematosus. Blood. 2004;104(1):143–8.CrossRefPubMed
39.
Chang ER, Pineau CA, Bernatsky S, Neville C, Clarke AE, Fortin PR. Risk for incident arterial or venous vascular events varies over the course of systemic lupus erythematosus. J Rheumatol. 2006;33(9):1780–4.PubMed
40.
Calvo-Alen J, Toloza SM, Fernandez M, Bastian HM, Fessler BJ, Roseman JM, et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXV. Smoking, older age, disease activity, lupus anticoagulant, and glucocorticoid dose as risk factors for the occurrence of venous thrombosis in lupus patients. Arthritis Rheum. 2005;52(7):2060–8.CrossRefPubMed
41.
Mok MY, Chan EY, Fong DY, Leung KF, Wong WS, Lau CS. Antiphospholipid antibody profiles and their clinical associations in Chinese patients with systemic lupus erythematosus. J Rheumatol. 2005;32(4):622–8.PubMed
42.
Mok CC, Tang SS, To CH, Petri M. Incidence and risk factors of thromboembolism in systemic lupus erythematosus: a comparison of three ethnic groups. Arthritis Rheum. 2005;52(9):2774–82.CrossRefPubMed
43.•
Lin JA, Liao CC, Lee YJ, Wu CH, Huang WQ, Chen TL. Adverse outcomes after major surgery in patients with systemic lupus erythematosus: a nationwide population-based study. Ann Rheum Dis. 2013. This study found that patients with SLE, especially those with a recent hospitalization for lupus, are at increased risk for post-operative VTE compared to controls.
44.
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295–306.CrossRefPubMed
45.
Reynaud Q, Lega JC, Mismetti P, Chapelle C, Wahl D, Cathebras P, Laporte S. Risk of venous and arterial thrombosis according to type of antiphospholipid antibodies in adults without systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev. 2014.
46.
Pengo V, Ruffatti A, Legnani C, Gresele P, Barcellona D, Erba N, et al. Clinical course of high-risk patients diagnosed with antiphospholipid syndrome. J Thromb Haemost. 2010;8(2):237–42.CrossRefPubMed
47.
Erkan D, Yazici Y, Peterson MG, Sammaritano L, Lockshin MD. A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford). 2002;41(8):924–9.CrossRef
48.
Hegde VA, Vivas Y, Shah H, Haybron D, Srinivasan V, Dua A, et al. Cardiovascular surgical outcomes in patients with the antiphospholipid syndrome—a case-series. Heart Lung Circ. 2007;16(6):423–7.CrossRefPubMed
49.
Cervera R, Bucciarelli S, Plasin MA, Gomez-Puerta JA, Plaza J, Pons-Estel G, et al. Catastrophic antiphospholipid syndrome (CAPS): descriptive analysis of a series of 280 patients from the “CAPS registry”. J Autoimmun. 2009;32(3–4):240–5.CrossRefPubMed
50.
Cervera R. Update on the diagnosis, treatment, and prognosis of the catastrophic antiphospholipid syndrome. Curr Rheumatol Rep. 2010;12(1):70–6.CrossRefPubMed
51.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e326S–50. PMCID: PMC3278059.PubMedCentralPubMed
52.
Cervera R, CAPS Registry Project Group. Catastrophic antiphospholipid syndrome (CAPS): update from the ‘CAPS registry’. Lupus. 2010;19(4):412–8.CrossRefPubMed
53.
Erkan D, Leibowitz E, Berman J, Lockshin MD. Perioperative medical management of antiphospholipid syndrome: hospital for special surgery experience, review of literature, and recommendations. J Rheumatol. 2002;29(4):843–9.PubMed
54.
Hatemi G, Silman A, Bang D, Bodaghi B, Chamberlain AM, Gul A, et al. Management of Behcet disease: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for the management of Behcet disease. Ann Rheum Dis. 2009;68(10):1528–34.CrossRefPubMed
55.
Desbois AC, Wechsler B, Resche-Rigon M, Piette JC, Huong Dle T, Amoura Z, et al. Immunosuppressants reduce venous thrombosis relapse in Behcet’s disease. Arthritis Rheum. 2012;64(8):2753–60.CrossRefPubMed
56.
Ahn JK, Lee YS, Jeon CH, Koh EM, Cha HS. Treatment of venous thrombosis associated with Behcet’s disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation. Clin Rheumatol. 2008;27(2):201–5.CrossRefPubMed
57.
Faurschou M, Obel N, Baslund B. High risk of pulmonary embolism and deep venous thrombosis but not of stroke in granulomatosis with polyangiitis (Wegener’s). Arthritis Care Res (Hoboken). 2014;66(12):1910–4.CrossRef
58.
Merkel PA, Lo GH, Holbrook JT, Tibbs AK, Allen NB, Davis Jr JC, et al. Brief communication: high incidence of venous thrombotic events among patients with Wegener granulomatosis: The Wegener’s Clinical Occurrence of Thrombosis (WeCLOT) study. Ann Intern Med. 2005;142(8):620–6.CrossRefPubMed
59.
Stassen PM, Derks RP, Kallenberg CG, Stegeman CA. Venous thromboembolism in ANCA-associated vasculitis—incidence and risk factors. Rheumatology (Oxford). 2008;47(4):530–4.CrossRef
60.
Allenbach Y, Seror R, Pagnoux C, Teixeira L, Guilpain P, Guillevin L, et al. High frequency of venous thromboembolic events in Churg-Strauss syndrome, Wegener’s granulomatosis and microscopic polyangiitis but not polyarteritis nodosa: a systematic retrospective study on 1130 patients. Ann Rheum Dis. 2009;68(4):564–7.CrossRefPubMed
61.
Avina-Zubieta JA, Bhole VM, Amiri N, Sayre EC, Choi HK. The risk of deep venous thrombosis and pulmonary embolism in giant cell arteritis: a general population-based study. Ann Rheum Dis. 2014.
62.
Caprini JA, Arcelus JI, Reyna JJ. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol. 2001;38(2 Suppl 5):12–9.CrossRefPubMed
63.
Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell Jr DA, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344–50.CrossRefPubMed
Metadata
Title
Postoperative Risk of Venous Thromboembolism in Rheumatic Disease Patients
Authors
Lauren E. Wong
Anne R. Bass
Publication date
01-02-2015
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 2/2015
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-014-0488-6

Other articles of this Issue 2/2015

Current Rheumatology Reports 2/2015 Go to the issue

Surgery and Perioperative Care (CR MacKenzie and SM Goodman, Section Editors)

Cervical Spine Disease in Rheumatoid Arthritis: Incidence, Manifestations, and Therapy

Antiphospholipid Syndrome (D Erkan, Section Editor)

The Challenge of Bleeding in Antiphospholipid Antibody-Positive Patients

Spondyloarthritis (MA Khan, Section Editor)

Spondyloarthritis and the Microbiome: New Insights From an Ancient Hypothesis

Vasculitis (L Espinoza, Section Editor)

Giant Cell Arteritis and Polymyalgia Rheumatica: an Update

Biosimilars (E Mysler, Section Editor)

Biosimilars: Clinical Interpretation and Implications for Drug Development

Orphan Diseases (B Manger, Section Editor)

Rheumatic Symptoms in Autoimmune Thyroiditis
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits