Objectives: Recent research suggests that rheumatoid arthritis increases the risk of venous thromboembolism. This study compared the risk of venous thromboembolism in patients with newly diagnosed rheumatoid arthritis initiating a biologic disease-modifying antirheumatic drug (DMARD) with those initiating methotrexate or a nonbiologic DMARD.
Methods: We conducted a population-based cohort study using US insurance claims data (2001-2012). Three mutually exclusive, hierarchical DMARD groups were used: (1) a biologic DMARD with and without nonbiologic DMARDs; (2) methotrexate without a biologic DMARD; or (3) nonbiologic DMARDs without a biologic DMARD or methotrexate. We calculated the incidence rates of venous thromboembolism. Cox proportional hazard models stratified by propensity score (PS) deciles after asymmetric PS trimming were used for 3 pairwise comparisons, controlling for potential confounders at baseline.
Results: We identified 29,481 patients with rheumatoid arthritis with 39,647 treatment episodes. From the pairwise comparison after asymmetric PS trimming, the incidence rate of hospitalization for venous thromboembolism per 1000 person-years was 5.5 in biologic DMARD initiators versus 4.4 in nonbiologic DMARD initiators and 4.8 in biologic DMARD initiators versus 3.5 in methotrexate initiators. The PS decile-stratified hazard ratio of venous thromboembolism associated with biologic DMARDs was 1.83 (95% confidence interval [CI], 0.91-3.66) versus nonbiologic DMARDs and 1.39 (95% CI, 0.73-2.63) versus methotrexate. The hazard ratio of venous thromboembolism in biologic DMARD initiators was the highest in the first 180 days versus nonbiologic DMARD initiators (2.48; 95% CI, 1.14-5.39) or methotrexate initiators (1.80; 95% CI, 0.90-3.62).
Conclusions: The absolute risk for venous thromboembolism was low in patients with newly diagnosed rheumatoid arthritis. Initiation of a biologic DMARD seems to be associated with an increased short-term risk of hospitalization for venous thromboembolism compared with initiation of a nonbiologic DMARD or methotrexate.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414700 | PMC |
| http://dx.doi.org/10.1016/j.amjmed.2014.11.025 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
External validation of a novel cancer-associated venous thromboembolism risk assessment score in a safety-net hospital.
Res Pract Thromb Haemost
January 2025
Section of Hematology & Medical Oncology, Boston University School of Medicine, Boston, Massachusetts, USA.
Background: Cancer-associated thrombosis (CAT) is a leading cause of death in patients diagnosed with cancer. However, pharmacologic thromboprophylaxis use in cancer patients must be carefully evaluated due to a 2-fold increased risk of experiencing a major bleeding event within this population. The electronic health record CAT (EHR-CAT) risk assessment model (RAM) was recently developed, and reports improved performance over the widely used Khorana score.
View Article and Find Full Text PDFSystematic Ultrasound Screening for Lower Extremity Deep Vein Thrombosis in ICU Patients with Severe COVID-19: A Randomized Clinical Trial.
J Intensive Care Med
January 2025
Servicio de Angiología, cirugía vascular y endovascular. Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Background: Venous thromboembolism (VTE), whether pulmonary embolism (PE) or deep vein thrombosis (DVT), is common in patients with COVID-19. Recommendations on systematic screening in the intensive care unit (ICU) are lacking.
Research Question: Is there any clinical benefit of systematic screening for DVT in critically ill patients with severe COVID-19?
Study Design And Methods: Single-center randomized clinical trial (RCT) of COVID-19 cases admitted to the ICU.
Vitamin K Antagonist Use and Level of Anticoagulation Control Among Patients at a Tertiary Hospital in Northern Tanzania.
J Cardiovasc Pharmacol Ther
January 2025
Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Background: Vitamin K antagonists (VKA) continue to be the principal anticoagulants for both the treatment and prevention of venous thromboembolism. The use of VKA often requires regular monitoring to avoid over-anticoagulation and prevent thromboembolic complications. The aim was to determine the indication for VKA use and factors associated with suboptimal anticoagulation control among patients in northern Tanzania.
View Article and Find Full Text PDFAssociation of Fibrinogen Aα Thr312Ala (rs6050) Polymorphism with Venous Thrombosis and Chronic Thromboembolic Pulmonary Hypertension: A Meta-Analysis.
Clin Appl Thromb Hemost
January 2025
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Background: Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Chronic thromboembolic pulmonary hypertension (CTEPH) typically arises from acute pulmonary embolism. The pathogenesis of them involves multiple risk factors such as genetic predisposition.
View Article and Find Full Text PDFCardiovascular safety of Janus kinase inhibitors in inflammatory bowel disease: a systematic review and network meta-analysis.
Ann Med
December 2025
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.
Background And Objective: Janus kinase (JAK) inhibitors (JAKinibs) are effective for inflammatory bowel disease (IBD), but their cardiovascular safety is inconclusive. We aim to assess the cardiovascular risks associated with JAKinibs in IBD patients.
Patients And Methods: Systematic searches of seven databases and ClinicalTrials.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!