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Increased risk of arterial thromboembolic events in transfusion-naïve thalassemia: a nationwide population-based study
  1. Xuan Liu1,
  2. Jianyun Wen1,
  3. Yiqi Xu1,
  4. Yongsheng Ruan1,
  5. Tiantian Yi1,
  6. Jung-Chien Chen2,
  7. Xuedong Wu1
  1. 1 Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
  2. 2 Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
  1. Correspondence to Dr Jung-Chien Chen, Department of Surgery, Min-Sheng General Hospital, Taoyuan 330, Taiwan; jackykenzero{at}gmail.com and Dr Xuedong Wu, Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; xuedongwu{at}163.com

Abstract

Transfusion-naïve thalassemia minor/trait is often associated with decreased risk of coronary artery diseases. The present study aimed to evaluate the effect of transfusion-naïve thalassemia on the incidence of arterial thromboembolic events using the National Health Insurance Research Database, Taiwan (2001–2010). Data from patients with transfusion-naïve thalassemia (n=2356) frequency matched with non-thalassemia subjects (n=9424) according to sex, age, and index year at a ratio of 1:4 were included. The risk of arterial thromboembolic events, cerebrovascular ischemic events, arterial embolism/thrombosis, peripheral embolism, myocardial infarction, myocardial ischemia, and angina pectoris in transfusion-naïve thalassemia were analyzed using Cox proportional hazard regression models. The transfusion-naïve thalassemia group had significantly higher risk of arterial thromboembolic events (aHR=1.28, 95% CI 1.07 to 1.52) and myocardial ischemia (aHR=1.41, 95% CI 1.13 to 1.76) as compared with the non-thalassemia group. In addition, they also had a significantly higher cumulative incidence of arterial thromboembolic event and myocardial ischemia. Interestingly, a higher risk of arterial thromboembolic events (aHR=1.58, 95% CI 1.22 to 2.04) and myocardial ischemia (aHR=1.73, 95% CI 1.25 to 2.41) was observed in men with thalassemia as compared with those without. Furthermore, patients with comorbidities had an increased risk of arterial thromboembolic events than did those without comorbidities. The effect of thalassemia on arterial thromboembolic events may be mainly attributed to the influence of thalassemia on myocardial ischemia, as no significant differences were observed in other outcomes evaluated in the present study. In conclusion, the present study confirms the increased risk of arterial thromboembolic events, mainly attributed to the dramatic increase in myocardial ischemia, inminor patients with transfusion-naïve thalassemia.

  • thrombosis
  • cardiovascular diseases
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Footnotes

  • Contributors XL: conception and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript; final approval of the manuscript; clinical studies. JW: conception and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript; final approval of the manuscript; clinical studies. YX: conception and design; acquisition of data; analysis and interpretation of data; guarantor of integrity of the entire study; statistical analysis. YR: conception and design; acquisition of data; analysis and interpretation of data; definition of intellectual content; literature research; clinical studies. TY: conception and design; acquisitionof data; analysis and interpretation of data; clinical studies; experimental studies. XW: conception and design; acquisition of data; analysis andinterpretation of data; final approval of the manuscript; obtaining funding; administrative, technical or material support; supervision. J-CC: conception and design; acquisition of data; analysis and interpretation of data; final approval of the manuscript; obtaining funding; administrative, technical or material support; supervision.

  • Funding This work was supported by: National Natural Science Foundation of China (Grant No. 81370608), the Guangdong Province Science and Technology Plan projects (Grant No. 2016A020215102), Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education (LC2016ZD017), clinical study on the treatment of children with hematological diseases with semimatched peripheral blood stem cell transplantation plus unrelated umbilical cord blood hematopoietic stem cell transplantation. Science and Technology Program of Guangzhou, China (201607010241). The treatment of severe β-thalassemia with haploid transplanted and sequential unrelated cord blood transplantation.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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