Infections, inflammation and venous thrombosis. An epidemiological perspective

PhD ceremony: Mr. Y.I.G.V. Tichelaar, 12.45 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Infections, inflammation and venous thrombosis. An epidemiological perspective

Promotor(s): prof. J.C. Kluin-Nelemans

Faculty: Medical Sciences

Inflammation and coagulation share many pathways. In this thesis we showed that infections, such as (upper) airway, gastro-intestinal and malaise symptoms, increase the risk of venous thrombosis about 2.5-fold. Chronic inflammatory and infectious diseases also increase the risk of venous thrombosis as high as 8-fold when having a flare-up of chronic inflammatory bowel disease. We showed that patients with HIV-infection have an increased risk of venous and arterial thrombosis and that a super infection with cytomegalovirus disturbs the coagulation hemostasis even more, tipping the balance towards a pro-coagulant state. Also, a high glucose level was associated with an increased risk of venous thrombosis, but conclusions about causality cannot be drawn from our studies. This is also true for high factor VIII levels. About 66% of high factor VIII levels at presentation remained high during and after treatment. An association with the acute phase was found which was not identified in previous studies. The highest levels of factor VIII were least affected by the acute phase reaction. It might be that these patients with an increased risk of a recidive venous thrombosis can be identified early (at presentation). Finally, we found that factor VIII:C levels, determined by one stage clotting assays and chromogenic assays, were falsely lowered by Rivaroxaban, a new anti-Xa oral anticoagulant. Physicians should be aware of this interference.