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Diabetics may suffer more complications of venous thromboembolism

NEW YORK (Reuters Health) – Diabetes may increase the risk of complications in patients with venous thromboembolism, a new study found.

Patients with diabetes were more likely to suffer recurrent deep vein thrombosis and major long-term bleeding, according to research published May 4 in the American Journal of Medicine.

“As clinicians, we need to now recognize the importance of diabetes as an overall cardiovascular risk factor. Not only is it a risk factor for heart attack and stroke, but also for venous thromboembolism,” Dr. Gregory Piazza, who led the study at Brigham and Women’s Hospital in Boston, Mass., told Reuters Health by email.

Dr. Piazza and his team examined the records of 2,488 patients with venous thromboembolism and found that 476 (19.1%) had a prior diagnoses of diabetes.

Deep vein thrombosis recurred in 14.9% of the patients with diabetes, compared to 10.7% of the other patients (p=0.01). And over the long term, major bleeding complications occurred in 16.4% of those with diabetes, compared to 11.7% of the rest (p=0.01).

But after adjusting for confounders, diabetes did not appear to influence the risk of long-term bleeding. Rather, the use of aspirin at discharge and a history of chronic kidney disease predicted bleeding.

Diabetics were also more likely to have comorbidities that could increase the risk of venous thromboembolism. More diabetics were immobile (52.5% vs. 43.6%), and had acute infectious illness (34.2% vs. 23%), heart failure (30.7% vs. 14.2%), chronic obstructive pulmonary disease (25.2% vs. 18.1%), ischemic heart disease (24.4% vs. 10.3%), and chronic kidney disease (15.3% vs. 6.1%), for example.

In the three months before the venous thromboembolism occurred, patients who were hospitalized for other, unrelated conditions were more likely to have received thromboprophylactic measures if they had diabetes (60.4% of diabetics vs 46.6% of the other patients). The researchers characterized the figure as a target for improvement, however, writing that more than a third of the diabetes patients did not receive prophylactic treatment.

Underusing prophylaxis is a major safety concern at medical centers, Dr. Piazza said.

He added, “Further efforts to identify patients at high risk for venous thromboembolism and to encourage appropriate prophylactic measures are needed.”

SOURCE: http://bit.ly/N4eeLq

Am J Med 2012.