Risk of Venous Thromboembolism Following Hemorrhagic Fever With Renal Syndrome: A Self-controlled Case Series Study

• Published in: Clinical infectious diseases 2018-01, Vol.66 (2), p.268-273
• Main Authors: Connolly-Andersen, Anne-Marie, Whitaker, Heather, Klingström, Jonas, Ahlm, Clas
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bleeding; Cerebral infarction; Child; Child, Preschool; Complications; Confidence intervals; Crosslinking; deep vein thrombosis; Embolism; Female; Females; Fever; Hantavirus; Health risks; Heart attacks; Hemorrhage; Hemorrhagic fever with renal syndrome; Hemorrhagic Fever with Renal Syndrome - complications; Hospitalization - statistics & numerical data; Humans; Incidence; Infant; Infant, Newborn; Kidney diseases; Kidneys; Male; Males; Medicin och hälsovetenskap; Middle Aged; Myocardial infarction; Patients; pulmonary embolism; Risk Assessment; Risk factors; Sweden - epidemiology; Thromboembolism; Thrombosis; venous thromboembolism; Venous Thromboembolism - epidemiology; viral haemorrhagic fever; Viruses; Young Adult
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/cix777

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. 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. 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. 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.