Artikel
Nationwide study on the risk of venous thromboembolism in non-traumatic osteonecrosis of femoral head
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Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: Endothelial dysfunction is a principal risk factor of osteonecrosis of femoral head (ONFH) and venous thromboembolism (VTE) [defined as deep venous thrombosis (DVT) or pulmonary embolism (PE)]. However, the risk of unprovoked VTE in non-traumatic ONFH patients remains unclear. The aim of our study was to investigate the relationship between ONFH and VTE.
Methods: Taiwan National Health Insurance Research Database (NHIRD) was utilized for this retrospective population-based cohort study (1997-2010). A total of 1,514 non-traumatic ONFH patients were identified from 1,000,000 general populations after excluding initially concomitant diagnoses of DVT and PE, those with history of lower limb surgery at enrollment, and VTE occurred within one year after surgery. The comparison group (n=15,140) without ONFH was set-up by matching study cohort with age, gender, income and urbanization in a 1:10 ratio. The distribution of demographic factors and the rate of comorbidities were compared between the study cohort and matched control cohort with the independent t test and Chi-square test. The Kaplan-Meier method was utilized to estimate cumulative incidences and Log-Rank test was performed to examine differences between the two groups. Furthermore, Cox proportional hazard regression models were used to compute the hazard ratios (HRs) after adjusting for age, gender, and comorbidities.
Results and Conclusion: The patients with non-traumatic ONFH had significantly higher frequency of unprovoked VTE than general population (1.19% v.s. 0.5%, p<0.0007). In further, the frequency of DVT was also significantly higher in the ONFH than non-ONFH group (0.99% v.s. 0.39%, p <0.0008), whereas the frequency of PE was similar between these two groups (p=0.4922). Additionally, Kaplan-Meier analysis demonstrated that cumulative incidence of VTE or DVT was remarkably higher in the ONFH than non-ONFH group (all p< 0.001). After adjusting for age, gender, and associated comorbidities with multivariate analysis, ONFH patients had 2.42-fold greater risk for developing DVT as compared to non-ONFH counterparts (95% CI 1.37 to 4.28, p=0.0023). Apart from ONFH, age >65 years and hypertension were also identified as risk factors for DVT occurrence. In conclusion, the incidence and risk of unprovoked VTE significantly increase in non-traumatic ONFH.