Author + information
Among patients with venous thromboembolism (VTE), risk factors of recurrence are poorly defined. Iron deficiency (ID) may promote thrombotic processes. We hypothesized that ID is associated with an increased risk of recurrent VTE in younger patients with unprovoked VTE.
In a prospective observational study, circulating ferritin (reflecting body iron stores) was investigated in 229 consecutive patients aged <65 years enrolled 3–12 months following the unprovoked first–ever VTE (age: 45±12 years, men: 51%, isolated deep vein thrombosis [DVT]: 50%, isolated pulmonary embolism [PE]: 27%, combined DVT and PE: 23%). There were the following exclusion criteria: history of heart failure, myocardial infarction, stroke, known malignancy, diabetes, chronic kidney disease or any cause of provoked VTE.
ID (serum ferritin <30 microg/L) was found in 47 (21%) of patients with VTE, and 22 (10%) patients had anemia (hemoglobin <13 g/dL in men and <12 g/dL in women). In a multiple logistic model, ID was more prevalent in women vs. men (38% vs. 3%), those with higher serum high sensitivity C–reactive protein (hsCRP ≥ vs. < 1.9 mg/L [median]: 25% vs. 16%), and anemic vs. non–anemic subjects (36% vs. 19%) (all p0.1). Serum ferritin was not related with any inherited thrombophilic factor (all p>0.1). During the 24–month follow–up, there were 24 (10%) recurrent VTE events (including 8 events in subjects on oral anticoagulation). In multivariable models, only ID and high serum hsCRP (irrespectively of hemoglobin, clinical profile, thrombophilia) predicted an increased rate of recurrent VTE (both p<0.05). The 2–year event–free survival rates were 46% vs. 91% in those with vs. without ID (p<0.001).
Depleted iron stores are found in one fifth of patients with the history of VTE. In this population, ID is accompanied by low–grade inflammation, compromised erythropoiesis, and female gender. The presence of ID is associated with the higher risk of recurrent VTE. It remains to be established whether the iron supplementation in those with depleted iron stores could prevent the further VTE.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Venous Thrombosis and Pulmonary Embolism
Abstract Category: 36. Vascular Medicine: Venous Disease
Presentation Number: 1296–157
- 2013 American College of Cardiology Foundation