**16.4 Rheumatoid arthritis**

Rheumatoid arthritis is not generally considered a risk factor for VTE, although abnormalities of coagulation factors have been found in patients with rheumatoid arthritis.206,207 Among 4,818,000 patients hospitalized in short-stay hospitals from 1979 to 2005 with rheumatoid arthritis who did not have joint surgery, the incidence of PE was 2.3%, and the relative risk of VTE compared with those who did not have rheumatoid arthritis was 1.99.208 Among patients younger than 50 years the relative risk was higher (2.13).208

### **16.5 Diabetes mellitus**

Among 92,240,000 patients with diabetes mellitus hospitalized from 1979 to 2005, 1,267,000 (1.4%) had VTE.209 The relative risk for VTE was increased only in patients younger than 50 years and was highest in patients aged 20 to 29 years (relative risk 5 1.73). In patients with diabetes mellitus who did not have obesity, stroke, heart failure, or cancer, compared with those who did not have diabetes mellitus and did not have any of these comorbid conditions, the relative risk for VTE was 1.52 in patients aged 20 to 29 years and 1.19 in patients 30 to 39 years. In older patients, the relative risk of VTE in patients with diabetes mellitus was not increased.209 Among all adults with diabetes mellitus, the relative risk of VTE was 1.05.209

#### **16.6 Human immunodeficiency virus**

Among 2,429,000 patients older than 18 years hospitalized in short-stay hospitals from 1990 through 2005 with human immunodeficiency virus (HIV) infection; the prevalence of VTE was 1.7% (relative risk 5 1.21).210 The prevalence of VTE in patients aged 30 to 49 years was also 1.7%, but the relative risk compared with patients who did not have HIV infection was higher (1.65).210

#### **16.7 Nephrotic syndrome**

16 Deep Vein Thrombosis

mutation, and increased levels of factor VIII.204 Based on data from the National Hospital Discharge Survey, among 4,927,000 hospitalized patients with chronic alcoholic liver disease from 1979 to 2006, the prevalence of VTE was 0.6% and among 4,565,000 hospitalized patients with chronic nonalcoholic liver disease it was 0.9%.201 The prevalence of VTE was higher in those with chronic alcoholic liver disease than with nonalcoholic liver disease, but

Both showed a lower prevalence of VTE than in hospitalized patients with most other medical diseases. It may be that both chronic alcoholic liver disease and chronic nonalcoholic liver disease have protective antithrombotic mechanisms although the

Among 19,519,000 hospitalized patients with a diagnosis of hypothyroidism from 1979 to 2005, 119,000 (0.61%) had PE (relative risk 5 1.64).205 DVT was diagnosed in 1.36% of hypothyroid patients (relative risk 5 1.62).205 The relative risk for PE in patients with hypothyroidism was highest in patients younger than 40 years (relative risk 5 3.99) and the relative risk for DVT was also highest in patients younger than 40 years (relative risk 5 2.25). Hyperthyroidism was not associated with an increased risk for VTE (relative risk 5 0.98).

Rheumatoid arthritis is not generally considered a risk factor for VTE, although abnormalities of coagulation factors have been found in patients with rheumatoid arthritis.206,207 Among 4,818,000 patients hospitalized in short-stay hospitals from 1979 to 2005 with rheumatoid arthritis who did not have joint surgery, the incidence of PE was 2.3%, and the relative risk of VTE compared with those who did not have rheumatoid arthritis was 1.99.208 Among

Among 92,240,000 patients with diabetes mellitus hospitalized from 1979 to 2005, 1,267,000 (1.4%) had VTE.209 The relative risk for VTE was increased only in patients younger than 50 years and was highest in patients aged 20 to 29 years (relative risk 5 1.73). In patients with diabetes mellitus who did not have obesity, stroke, heart failure, or cancer, compared with those who did not have diabetes mellitus and did not have any of these comorbid conditions, the relative risk for VTE was 1.52 in patients aged 20 to 29 years and 1.19 in patients 30 to 39 years. In older patients, the relative risk of VTE in patients with diabetes mellitus was not increased.209 Among all adults with diabetes mellitus, the relative risk of VTE was 1.05.209

Among 2,429,000 patients older than 18 years hospitalized in short-stay hospitals from 1990 through 2005 with human immunodeficiency virus (HIV) infection; the prevalence of VTE was 1.7% (relative risk 5 1.21).210 The prevalence of VTE in patients aged 30 to 49 years was also 1.7%, but the relative risk compared with patients who did not have HIV infection was

patients younger than 50 years the relative risk was higher (2.13).208

the difference was small and of no clinical consequence.201

mechanisms differ.

**16.3 Hypothyroidism** 

**16.4 Rheumatoid arthritis** 

**16.5 Diabetes mellitus** 

higher (1.65).210

**16.6 Human immunodeficiency virus** 

From 1979 to 2005, 925,000 patients were discharged from short-stay hospitals with nephrotic syndrome and 14,000 (1.5%) had DVT (relative risk 5 1.72).211 In patients aged 18 to 39 years the relative risk for DVT was 6.81.211 Renal vein thrombosis was so uncommon that too few were reported to calculate its prevalence. Therefore, PE, if it occurs, is likely to be due to emboli from the lower extremities and not the renal vein.

#### **16.8 Sickle cell disease**

Sickle cell disease does not seem to be a risk factor for DVT.212 Among 1,804,000 patients hospitalized in short-stay hospitals with sickle cell disease from 1979 to 2003, 11,000 (0.61%) had a discharge diagnosis of DVT, which was not more than in African Americans without sickle cell disease (0.81%).212 Among patients with sickle cell disease, a discharge diagnosis of PE was made in 0.50% compared with 0.33% who did not have sickle cell disease. Regarding patients younger than 40 years, 0.44% had PE, whereas among patients who did not have sickle cell disease, 0.12% had PE.212 The higher prevalence of apparent PE in patients with sickle cell disease compared with African American patients the same age who did not have sickle cell disease, and the comparable prevalence of DVT in both groups, is compatible with the concept that thrombosis in situ may be present in many.

#### **16.9 Systemic lupus erythematosus**

Systemic lupus erythematosus is believed to be independently associated with the risk of developing DVT.61 The odds ratio for DVT in patients with systemic lupus erythematosus, compared with those without it, was 4.3.61

#### **16.10 Behçet disease**

Behcet disease is a rare multisystem inflammatory disorder of unknown cause.213 VTE occurs in about one-fifth of patients with Behc¸ et disease.213

#### **16.11 Paroxysmal nocturnal hemoglobinuria**

Review of 13 retrospective studies of patients with paroxysmal nocturnal hemoglobinuria showed a 30% prevalence of venous thrombotic events in patients from Western nations.214 The majority was within the hepatic and mesenteric veins.214

#### **16.12 Buerger disease**

PE associated with thromboangiitis obliterans (Buerger disease) is rare, and to our knowledge, limited to a case report.215
