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: https://doi.org/10.1093/cid/cix777


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.

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  • Item ORO ID
  • 54985
  • Item Type
  • Journal Item
  • ISSN
  • 1058-4838
  • Project Funding Details
  • Funded Project NameProject IDFunding Body
    Not SetM15 58Foundation for Clas Groschinsky’s Memorial Fund
    Not SetNot SetHeart Foundation of Northern Sweden
    Not SetSLS-589151Swedish Society of Medicine
    Not Set20150752Swedish Heart-Lung Foundation
    Not SetVLL-579011County Council of Västerbotten
    Not SetVLL-578991County Council of Västerbotten
    Not SetFS 2.1.12- 1605-14Medical Faculty, Umeå University
    Not SetSB12-0003Swedish Foundation for Strategic Research
    Not SetK2015-56X-22774-01-3Swedish Research Council
  • Keywords
  • hemorrhagic fever with renal syndrome; venous thromboembolism; deep vein thrombosis; pulmonary embolism; viral haemorrhagic fever
  • Academic Unit or School
  • Faculty of Science, Technology, Engineering and Mathematics (STEM) > Mathematics and Statistics
    Faculty of Science, Technology, Engineering and Mathematics (STEM)
  • Copyright Holders
  • © 2017 The Authors
  • Depositing User
  • ORO Import