Long-Term Risk of VTE in Sarcoidosis: A Nationwide Cohort Study

Abstract

BackgroundChronic inflammation is increasingly recognised as a risk factor for venous thromboembolism (VTE), but unlike other inflammatory diseases including systemic lupus erythematosus and rheumatoid arthritis, data on the risk of VTE in patients with sarcoidosis are sparse. Research questionDo patients with sarcoidosis have a higher long-term risk of VTE (pulmonary embolism or deep venous thrombosis, and each of these individually) compared with the background population? Study designand methods: Using Danish nationwide registries, patients >18 years with newly diagnosed sarcoidosis (>2 in-/outpatient visits, 1996-2020) without prior VTE were matched 1:4 by age, sex, and comorbidities with individuals from the background population. The primary outcome was venous thromboembolism. ResultsWe included 14,742 patients with sarcoidosis and 58,968 matched individuals (median age 44.7 years; 57.2% males). The median follow-up was 8.8 years. Absolute 10-year risks of outcomes for patients with sarcoidosis vs. the background population were: VTE, 2.9% vs. 1.6% (P<0.0001); pulmonary embolism, 1.5% vs. 0.7% (P<0.0001); and deep venous thrombosis, 1.6% vs. 1.0% (P<0.0001). In multivariable Cox regression, sarcoidosis was associated with an increased rate of all outcomes in the first year after diagnosis (VTE: HR 4.94 [95% CI, 3.61-6.75]) and after the first year (VTE: HR 1.65 [95% CI, 1.45-1.87]) compared with the background population. These associations persisted when excluding patients with a history of cancer and censoring patients with incident cancer during follow-up. Three-month mortality was not significantly different between patients with VTE with and without sarcoidosis (adjusted HR 0.84 [95% CI, 0.61-1.15]). InterpretationIn this nationwide cohort study, sarcoidosis was associated with a higher long-term risk of VTE compared with a matched background population.