The risk of venous thromboembolism and physical activity level, especially high level: a systematic review

H Danin-Mankowitz,F Braunschweig,A Ugarph-Morawski,P Wändell

doi:10.1007/s11239-020-02372-5

Abstract

Venous thromboembolism (VTE) is the third most common cause of cardiovascular disease. Connection between high level of physical activity (PA) and the onset of VTE is unknown. We searched the literature on the possible association between PA level, especially high levels, and the risk of VTE. A systematic review was carried out to identify relevant articles on the relation between PA level and VTE. The initial search was conducted together with the Karolinska Institutet University Library in February 2018, with follow-up searches after that. In total, 4383 records were found and then screened for exclusion of duplicates and articles outside the area of interest. In total, 16 articles with data on 3 or more levels of PA were included. Of these, 12 were cohort and 4 were case-control studies. Totally 13 studies aimed at investigating VTE cases primarily, while three studies had other primary outcomes. Of the 16 studies, five found a U-shaped association between PA level and VTE risk, although non-significant in three of them. Two articles described an association between a more intense physical activity and a higher risk of VTE, which was significant in one. Nine studies found associations between increasing PA levels and a decreasing VTE risk. Available literature provides diverging results as to the association between high levels of PA and the risk of venous thromboembolism, but with several studies showing an association. Further research is warranted to clarify the relationship between high level PA and VTE.

Highlights

Venous thromboembolism (VTE) is the third most common cause of cardiovascular disease, after coronary artery disease and stroke [1]
One study found an association between increased level of physical activity (PA) and a greater risk of VTE [1]
In the article by Tsai et al [23], two measures of physical activity were applied because of two pooled cohorts, the ARIC (Atherosclerosis Risk In Communities) study used a score and the CHS (Cardiovascular Health Study) assessing kcal/week. We choose the latter measure allowing for a better discrimination of different PA levels

Summary

Introduction

Venous thromboembolism (VTE) is the third most common cause of cardiovascular disease, after coronary artery disease and stroke [1]. The annual incidence of VTE in Sweden is estimated at 150–200 per 100,000 person-years and the risk increases with age [2, 3]. In Sweden, over 11,000 patients are nursed annually in hospitals because of VTE, and around. The risk of venous thromboembolism and physical activity level, especially high level: a. 40,000 medical visits within outpatient care are due to VTE [4]. VTE can express itself in various ways, from a completely asymptomatic thrombosis to a massive lung embolization with fatal outcome. There are models to predict recurrent VTE, above all the Vienna model [6], with a higher recurrent risk among men, patients with proximal DVT or PE, and higher D-dimer levels

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Results