Risk of Venous Thromboembolism Following Hemorrhagic Fever With Renal Syndrome: A Self-controlled Case Series Study

Connolly-Andersen, Anne-Marie; Whitaker, Heather; Klingström, Jonas and Ahlm, Clas (2018). Risk of Venous Thromboembolism Following Hemorrhagic Fever With Renal Syndrome: A Self-controlled Case Series Study. Clinical Infectious Diseases, 66(2) pp. 268–273.

DOI (Digital Object Identifier) Link:	https://doi.org/10.1093/cid/cix777
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Abstract

Background. Bleeding is associated with viral hemorrhagic fevers; however, thromboembolic complications have received less attention. Hemorrhagic fever with renal syndrome (HFRS) is a mild viral hemorrhagic fever caused by Puumala hantavirus. We previously identified HFRS as a risk factor for myocardial infarction and stroke, but the risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is unknown.
Methods. Personal identity numbers from the Swedish HFRS database were cross-linked with the National Patient register to obtain information on all causes for hospitalization during 1964 to 2013. The self-controlled case series method was used to calculate the incidence rate ratio (IRR) for first VTE, DVT, and PE during 1998 to 2013.
Results. From 7244 HFRS patients, there were 146 with a first VTE of which 74 were DVT and 78 were PE, and 6 patients had both DVT and PE. The overall risk for a VTE was significantly higher during the first 2 weeks following HFRS onset, with an IRR of 64.3 (95% confidence interval [CI], 36.3–114). The corresponding risk for a DVT was 45.9 (95% CI, 18–117.1) and for PE, 76.8 (95% CI, 37.1–159). Sex interacted significantly with the association between HFRS and VTE, with females having a higher risk compared with males.
Conclusions. A significantly increased risk for VTE was found in the time period following HFRS onset. It is important to keep this in mind and monitor HFRS patients, and possibly other viral hemorrhagic fever patients, for early symptoms of VTE.

Item Type:

Journal Item

2017 The Authors

ISSN:

1058-4838

Project Funding Details:

Funded Project Name	Project ID	Funding Body
Not Set	M15 58	Foundation for Clas Groschinsky’s Memorial Fund
Not Set	Not Set	Heart Foundation of Northern Sweden
Not Set	SLS-589151	Swedish Society of Medicine
Not Set	20150752	Swedish Heart-Lung Foundation
Not Set	VLL-579011	County Council of Västerbotten
Not Set	VLL-578991	County Council of Västerbotten
Not Set	FS 2.1.12- 1605-14	Medical Faculty, Umeå University
Not Set	SB12-0003	Swedish Foundation for Strategic Research
Not Set	K2015-56X-22774-01-3	Swedish Research Council