Abstract
BackgroundIncreasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE) against a background of genetic and acquired risk factors. The role of psychosocial factors for the risk of recurrent VTE has not previously been examined. We hypothesized that depressive symptoms in patients with prior VTE are associated with an increased risk of recurrent VTE.MethodsIn this longitudinal observational study, we investigated 271 consecutive patients, aged 18 years or older, referred for thrombophilia investigation with an objectively diagnosed episode of VTE. Patients completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). During the observation period, they were contacted by phone and information on recurrent VTE, anticoagulation therapy, and thromboprophylaxis in risk situations was collected.ResultsClinically relevant depressive symptoms (HADS-D score ≥8) were present in 10% of patients. During a median observation period of 13 months (range 5-48), 27 (10%) patients experienced recurrent VTE. After controlling for sociodemographic and clinical factors, a 3-point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE (OR 1.44, 95% CI 1.02, 2.06). Compared to patients with lower levels of depressive symptoms (HADS-D score: range 0-2), those with higher levels (HADS-D score: range 3-16) had a 4.1-times greater risk of recurrent VTE (OR 4.07, 95% CI 1.55, 10.66).ConclusionsThe findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors. An increased risk might already be present at subclinical levels of depressive symptoms.
Highlights
The etiology of incident venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) of the leg and pulmonary embolism (PE), is multicausal, whereby genetic and acquired risk factors determine a person’s risk at a specific point in time [1]
After controlling for sociodemographic and clinical factors, a 3point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE
The findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors
Summary
The etiology of incident venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) of the leg and pulmonary embolism (PE), is multicausal, whereby genetic and acquired risk factors determine a person’s risk at a specific point in time [1]. Unprovoked VTE, proximal DVT and/or PE increase the risk of VTE recurrence, while extended oral anticoagulation (OAC) therapy lowers the risk [12]. Other important risk factors for VTE recurrence include higher age, male sex, obesity, high levels of coagulation factors, and D-dimer levels 250 ng/ml after discontinuing oral OAC therapy [11,12,13]. Whether psychosocial factors are associated with an increased risk of VTE recurrence has not previously been investigated. Increasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE) against a background of genetic and acquired risk factors.
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