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Surgery As a Trigger for Incident Venous Thromboembolism: Results from a Population-Based Case-Crossover Study
Dana Meknas1,2, Sigrid K Brækkan1,3, John-Bjarne Hansen1,3
1Department of Clinical Medicine, Thrombosis Research Group, UiT-The Arctic University of Norway, Tromsø, Norway.
TH Open : Companion Journal to Thrombosis and Haemostasis
|September 22, 2023
Summary
Major surgery significantly increases the risk of venous thromboembolism (VTE). However, this risk is partly explained by other factors like immobilization and infection that often accompany surgery.
Area of Science:
- Medical research
- Epidemiology
- Clinical investigation
Background:
- Surgery is a known transient risk factor for venous thromboembolism (VTE).
- The specific impact of major surgery as a VTE trigger requires further investigation using robust study designs.
Purpose of the Study:
- To examine the role of major surgery as a trigger for incident VTE.
- To adjust for other co-occurring VTE triggers in a population-based case-crossover study.
Main Methods:
- A case-crossover study involving 531 cancer-free VTE cases from the Tromsø Study cohort.
- Conditional logistic regression was used to estimate odds ratios (ORs) for VTE associated with major surgery.
- Triggers were assessed in the 90 days before VTE and four preceding 90-day control periods.
Main Results:
- Surgery was identified as a trigger in 16.0% of hazard periods versus 1.8% of control periods (OR=11.40).
- The OR for VTE associated with surgery decreased to 3.31 after adjusting for immobilization, infection, trauma, blood transfusion, and central venous catheter.
- Mediation analysis indicated that immobilization and infection explained 51.4% of the surgery-VTE association.
Conclusions:
- Major surgery is a significant trigger for VTE.
- The association between surgery and VTE risk is partially mediated by other factors, notably immobilization and infection.
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