Long-term incidence, risk factors and complications for venous thromboembolism in patients with systemic lupus erythematosus

Nossent, JC; Keen, HI; Preen, DB; Inderjeeth, CA

doi:10.1177/09612033241247359

Lupus & antiphospholipid syndrome

Long-term incidence, risk factors and complications for venous thromboembolism in patients with systemic lupus erythematosus

LupusPublished 24 Apr 2024Retrospective cohort study

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Authors' conclusion

VTE affected 12.8% of patients with SLE at six times the VTE rate in controls with aPL as the strongest, but not the only risk factor in SLE. The risk of PH was increased in both groups following PE, but VTE did not associate with an increased risk of arterial events.

Study context

Population: Patients with systemic lupus erythematosus (SLE) and matched hospitalised controls, Western Australia, 1985–2015
Participants: 1,854 vs 12,107

Exposure: SLE vs matched hospitalised controls
SLEn = 1,854
Controlsn = 12,107reference
Outcome: First VTE (VT and PE): frequency and IR per 1000 PY

Methodological detailsstate-wide longitudinal hospital data, matched hospitalised controls

State-wide longitudinal hospital data
Matched hospitalised controls

Main finding

As reported in the abstract

First VTE

SLE

12.8

%

Controls

3.3%

Each group vs controlsEstimate (95% CI)

SLE

OR 4.26(3.60–5.05)

SLE

RR 6.64(5.56–7.79)

Observational data: associations, not effects.

Further findings

VTE recurrence

P < 0.01

SLE24.1%

Controls10.2 %

Disease risk factors for venous thromboembolic event (VTE) in SLE

	← Lower risk ←→ Higher risk →	aHR (95% CI)
aPL	0.10.31310	4.24 (2.50–7.19)
Serositis	0.10.31310	2.70 (1.86–3.91)
LN	0.10.31310	1.75 (1.25–2.33)
Thrombocytopenia	0.10.31310	1.65 (1.10–2.49)
	0.10.31310Adjusted hazard ratio (log scale)

Outcome	← Lower risk with SLE ←→ Higher risk with SLE →	aHR (95% CI)
Pulmonary hypertension after PESLEvs Controls	0.050.21520	6.47 (3.73–11.23)
Death after VTE · 10 years of follow-upSLEvs Controls	0.050.21520	2.02 (1.50–2.70)
	0.050.21520Adjusted hazard ratio (log scale)

Pulmonary hypertension after pulmonary embolism (PE)

	← Lower risk ←→ Higher risk →	aHR (95% CI)
Controls	0.050.21520	9.09 (3.50–23.63)
	0.050.21520Adjusted hazard ratio (log scale)

Death after VTE · 10 years of follow-up

	← Lower risk ←→ Higher risk →	aHR (95% CI)
Controls	0.10.31310	6.63 (5.21–8.42)
	0.10.31310Adjusted hazard ratio (log scale)

Incidence rates (IR) of PE in SLE over three study decades

Declined from 7.74 to 3.75/1000 person years (PY) (p < .01); no changes for venous thrombosis (VT) or in controls

Disease risk factors for VTE in SLE

Arterial hypertension, smoking and obesity were independent VTE risk factors for both groups

Pulmonary hypertension after PE

VTE not associated with increased risk for arterial events

Original publication

Long-term incidence, risk factors and complications for venous thromboembolism in patients with systemic lupus erythematosus. Lupus. Published 24 April 2024. doi:10.1177/09612033241247359

Read the original article ↗

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