Deep vein thrombosis related to environment (Review)

Long-term exposures to ambient particulate matter and ozone pollution with lower extremity deep vein thrombosis after surgical operations: a retrospective case-control study in Beijing, China

BACKGROUND

Lower extremity deep vein thrombosis (LEDVT) after surgical operations is a common and fatal disease leading to unfavorable outcomes including death. Nevertheless, there has been insufficient evidence on the associations between ambient air pollution and LEDVT, particularly studies from developing regions.

METHODS

Based on 302 LEDVT cases and 302 controls in a general hospital in Beijing, China, this unmatched retrospective case-control study investigated the associations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), and ozone (O3) with odds of LEDVT.

RESULTS

Per 10 μg/m3 increase in PM2.5, PM10, and O3 at 3-month, 6-month, and 2-year average was associated with increased LEDVT odds [odds ratios (ORs) for PM2.5: 1.10 (95%CI: 1.05, 1.14), 1.14 (95%CI: 1.09, 1.18), and 1.30 (95%CI: 1.06, 1.61); ORs for PM10: 1.06 (95%CI: 1.02, 1.10), 1.12 (95%CI: 1.08, 1.16), and 1.29 (95%CI: 1.03, 1.61); ORs for O3: 1.00 (95%CI: 0.96, 1.04), 1.16 (95%CI: 1.02, 1.31), and 2.08 (95%CI: 1.03, 4.18), respectively]. The stratified analyses, exposure-responses curves, and sensitivity analyses further highlighted the robustness of our findings.

CONCLUSIONS

Long-term exposures to ambient PM2.5, PM10, and O3 may increase the risk of LEDVT in patients after surgical operations. The results may be implicated in the prevention and control of adverse clinical outcomes of surgical patients associated with ambient air pollution.

Long-Term Exposure to Air Pollution and Incidence of Venous Thromboembolism in the General Population: A Population-Based Retrospective Cohort Study

To date, the relationship between air pollutants and venous thromboembolism (VTE) has not been well established. Our aim is to investigate the association between ambient air pollutants and the incidence of VTE using the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database. From 2003 to 2015, 338,616 subjects from the general population not previously diagnosed with VTE were included. The long-term average concentration of air pollutants before diagnosis for each subject was calculated. During the study period, there were 3196 incident cases of VTE. After adjusting for age, gender, economic status, body mass index, physical activity, smoking, alcohol consumption, comorbid diseases, and meteorological variables, the risk of VTE was observed to increase significantly with the long-term average concentration of particulate matter < 10 μm in diameter: PM10 (hazard ratio (HR) = 1.064 (95% confidence interval [CI] 1.053−1.074) for 1 μg/m3), SO2 (HR = 1.118 (95% CI 1.079−1.158) 1 ppb), and O3 (HR = 1.039 (95% CI 1.026−1.053) for 1 ppb), respectively. A difference between the date of the health screening and the date of diagnosis of the disease was observed. Long-term exposure to air pollutants including PM10, SO2, and O3 may be an independent risk factor for the development of VTE.

Association between air temperature, air pollution and hospital admissions for pulmonary embolism and venous thrombosis in Italy

BACKGROUND

Previous studies reported a link between short-term exposure to environmental stressors (air pollution and air temperature) and atherothrombotic cardiovascular diseases. However, only few of them reported consistent associations with venous thromboembolism (VTE). Our aim was to estimate the association between daily air temperature and particulate matter (PM) air pollution with hospital admissions for pulmonary embolism (PE) and venous thrombosis (VT) at national level in Italy.

METHODS

We collected daily hospital PE and VT admissions from the Italian Ministry of Health during 2006-2015 in all the 8,084 municipalities of Italy, and we merged them with air temperature and daily PM10 concentrations estimated by satellite-based spatiotemporal models. First, we applied multivariate Poisson regression models at province level. Then, we obtained national overall effects by random-effects meta-analysis.

RESULTS

This analysis was conducted on 219,952 PE and 275,506 VT hospitalizations. Meta-analytical results showed weak associations between the two exposures and the study outcomes in the full year analysis. During autumn and winter, PE hospital admissions increased by 1.07% (95% confidence intervals [CI]: 0.21%; 1.92%) and 0.96% (95% CI: 0.07%; 1.83%) respectively, per 1 °C decrement of air temperature in the previous 10 days (lag 0-10). In summer we observed adverse effects at high temperatures, with a 1% (95% CI: 0.10%; 1.91%) increasing risk per 1 °C increment. We found no association between VT and cold temperatures.

CONCLUSION

Results show a significant effect of air temperature on PE hospitalizations in the cold seasons and summer. No effect of particulate matter was detected.

Venous thromboembolism in hospital emergency room. A retrospective study on climatic effect

Several cardiovascular conditions exhibit seasonality in frequency and mortality, but little is known about the seasonality of Venous ThromboEmbolism (VTE), a very relevant medical condition, and seasonal influences are still conflicting. Patients having co-morbidities, individual suffered from dyspnea, swelling, edema of lower limb, pain (chest, lower limbs) are admitted frequently to the hospital emergency room (HER), particularly. Both mark a potential risk for VTE, that can be increased also by seasonality. A four years retrospective analysis (2016-2019) was carried out in individuals and patients admitted to the HER of the Hospital of Catania (a Mediterranean city of Sicily, Italy) to evaluate the VTE frequency and its seasonal differences, common symptoms, potential usage of some common laboratory tests. Dyspnea, swelling, edema of lower limb and pain (chest, lower limbs) were considered to suspect pulmonary embolism (PE) or for deep vein thrombosis of lower limb (DVT). Platelet count, platelet volume, fibrinogen, C-reactive protein, and D-dimer were considered. VTE frequency per year was 2.9/10,000 (2016), 4.9/10,000 (2017) 3.6/10,000 (2018), and 5.1/10,000 (2019) respectively. Dyspnea was highly frequent for PE, edema and lower limb pain were frequent in DVT patients. Fibrinogen, C reactive protein, and D-dimer values were found raised in all the VTE patients. Platelet volume was found higher in DVT than PE VTE events that occurred in warm periods were modestly greater (57 VTE: 38 DVT, 19 PE) compared to cold months (52 VTE: 34 DVT, 18 PE). Our results could be explained by the increased sweating due to the high temperatures, which in turn, can affect both on plasma concentration and on hematocrit value coupled to the reduction in atmospheric pressure determining both a hyper-coagulative condition. Climate seasonal characteristics, and environmental conditions in Catania city (Sicily) may be as reasonable items in expecting on different VTE rates in warm period compared to cold. This study highlights no specific symptoms, and confirms the common lab tests for individuals and patients admitted to HER as simple and helpful tools in initiating none or mini-invasive diagnostic strategy for the VTE. Finally, the climate/seasonality coupled with latitude can have a direct influence on the incidence of DVT.

Seasonal association between ambient fine particulate matter and venous thromboembolism in Beijing, China: a time-series study

Little is known about the influence of ambient fine particulate matter (PM2.5) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0-10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0-2 corresponded to a 0.64% (95% confidence interval: 0.55-0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m3 increase in PM2.5 concentrations on lag days 0-3 corresponded to a 0.82% (95% confidence interval: 0.67-0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations.

Correlation between climatic and biochemical parameters in etiopathogenesis of unprovoked deep vein thrombosis of the lower limbs

AIM

Beside the intention of early detection and optimal treatment of deep venous thrombosis (DVT), the aim of this study was to investigate the influence of chronobiological rhythms on the etiopathogenesis of unprovoked deep vein thrombosis of the lower limbs with monitoring of seasonal variations in biochemical parameters.

PATIENTS AND METHODOLOGY

The prospective clinical trial included all consecutive hospitalized patients and outpatients diagnosed with DVT at the Vascular Surgery Clinic of the Clinical Center in Niš, starting from January 2013 to December 2014.

RESULTS

There was no statistically significant difference in correlation between the distribution of the incidence of DVT of the lower limbs (p = 0.582), sex (p = 0.350), age (p = 0.385) and localization (p = 0.886) and the seasons. Creatinine levels were significantly higher in patients who developed DVT in spring than in those who developed DVT in winter (p < 0.05), while LDL cholesterol levels were significantly higher in patients diagnosed with DVT in winter than in those diagnosed with DVT in autumn (p < 0.05).

CONCLUSION

According to the results of the study, it can be concluded that in the territory of South Serbia, the seasons are not significantly related to the incidence, sex, age and localization of unprovoked DVT of the lower limbs. Creatinine levels were significantly higher in patients who developed DVT in spring than in those who developed DVT in winter, while LDL cholesterol levels were significantly higher in patients during winter than during autumn.

Air pollution and hospital admissions due to deep vein thrombosis (DVT) in Ahvaz, Iran

There are limited studies on the relation between short-term exposure to air pollutants and the risk of deep venous thrombosis (DVT). The aim of this study was to determine the relation between the concentration of these pollutants and the risk of hospital admissions due to DVT in Ahvaz, which is one of the world's highly polluted cities. Daily data on pollutants including O₃, NO, NO₂, SO₂, CO, PM₁₀, and PM_2.5and DVT hospital admissions were collected from2008until 2018. Quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays, and holidays were used to assess the relation between the daily average of air pollutants and hospital admission for DVT. The results showed that there was a significant increase in hospital admissions due to DVT in the total, men, women, and elderly populations in relation to NO and NO₂. There was also a significant increase in DVT hospital admissions in the male and ≤60 years populations related to PM₁₀; and among the female and ≤60 years old populations, related to PM_2.5. Finally, the results showed that there were significant positive associations between SO2 and CO exposure and the incidence of DVT hospital admissions among men and women, respectively. The results of this study show the possible effect of short-term exposure to air pollution on the risk of DVT. Further studies are required to investigate whether direct interventions through industry and government policy may alter the impact of specific pollutants in order to alter the incidence of DVT and other identified health complications.

Correlation between short-term air pollution exposure and unprovoked lung embolism. Prospective observational (Contamina-TEP Group)

BACKGROUND

The aim was to analyze the temporal relationship between short-term air pollution exposure and acute symptomatic unprovoked pulmonary embolism (PE).

PATIENTS/METHODS

We performed a prospective, multicenter study in consecutive patients diagnosed with acute symptomatic unprovoked PE from February 2012 to January 2013. We analyzed demographic and clinical data, patients' addresses, meteorological and air pollutants data (PM₁₀, SO₂, CO, NO₂, ozone emission data). We considered the number of days the patient had symptoms, and the study period constituted the previous 30 days. Likewise, the mean annual data of the reference season were calculated as well as the data of the 30-day study period corresponding to the same dates in the previous 3 years in order to obtain the monthly mean of the different pollutants for each period.

RESULTS

A total of 162 patients with acute symptomatic PE were recruited (43.2% unprovoked PE). The air pollutants could be determined in 50% of the patients with unprovoked PE, and a final analysis was performed in 35 patients. In the multiple comparison analysis to verify a possible correlation between the study period and the annual median, only NO₂ showed a statistically significant association (p = 0.009). When comparing the study period with the previous 3 years, only NO₂ maintained a statistically significant association for the 3 study periods.

CONCLUSIONS

We found a relationship between short-term exposure to NO₂ and the presence of unprovoked PE.

The risk of lower-limb superficial vein thrombosis relative to lower-limb venous thrombotic events is not increased in winter months

OBJECTIVES

Ambient temperature (that impacts differently venous flow in superficial and deep veins) could have a different effect on the risk of superficial and deep venous thrombosis. We searched for a trimestral variation of the risk of superficial venous thrombosis among all lower-limb thrombotic events (lower-limb thrombotic events = superficial venous thrombosis + deep venous thrombosis).

METHODS

We retrospectively analyzed the results of venous ultrasound investigations performed among 11,739 patients (aged 67 ± 19 years old, 56.1% males) referred for suspected lower-limb thrombotic events over a 12-year period. Chi-square test was used to compare the superficial venous thrombosis/lower-limb thrombotic events ratio observed by trimesters to a homogeneous distribution.

RESULTS

The proportion of lower-limb thrombotic events were 30.7%, 28.8%, 31.1%, and 31.4% (Chi²: 0.133; p = 0.987) of total investigations, while that of superficial venous thrombosis among all lower-limb venous thrombotic events were 27.2%, 30.0%, 31.4%, and 31.0%, for the first, second, third, and fourth trimesters respectively (Chi²: 0.357; p: 0.949).

CONCLUSION

No trimestral variation of the superficial venous thrombosis/lower-limb venous thrombotic events ratio was observed.

Effect of particulate matter-bound metals exposure on prothrombotic biomarkers: A systematic review

Environmental pollution is an important modifiable determinant for preventing cardiovascular diseases. Acute exposure to air pollution is linked to severe adverse cardiovascular events, including venous thromboembolism risk. The adverse health effects seem to arise from blood-borne metals and transition metal components from exposure to particulate matter that, when breathed, passes through the lungs into the heart and the blood stream. Pollution affects health via mechanisms including oxidative stress and inflammation, and metals may have a detrimental effect on both the blood cells, particularly platelets, and circulation. Some evidences demonstrates atherotrombotic consequences of acute and chronic exposure to air pollution, but few studies have examined exposure effects on the prothrombotic biomarkers leading to venous thromboembolism. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we performed a systematic review (14 papers) of the past twelve years, focusing on the relationship between inhalable airborne metal exposures and coagulative biomarker disorders leading to lower limb venous thromboembolisms, e.g., deep vein thrombosis. Results support the hypothesis that exposure to inhalable metals, as elemental compounds in particulate matter, cause changes or activation of a number of human prothrombotic hemostatic biomarkers.

Particulate Matter Air Pollution: Effects on the Cardiovascular System

Air pollution is a complex mixture of gaseous and particulate components, each of which has detrimental effects on human health. While the composition of air pollution varies greatly depending on the source, studies from across the world have consistently shown that air pollution is an important modifiable risk factor for significantly increased morbidity and mortality. Moreover, clinical studies have generally shown a greater impact of particulate matter (PM) air pollution on health than the gaseous components. PM has wide-ranging deleterious effects on human health, particularly on the cardiovascular system. Both acute and chronic exposure to PM air pollution is associated with increased risk of death from cardiovascular diseases including ischemic heart disease, heart failure, and ischemic/thrombotic stroke. Particulate matter has also been shown to be an important endocrine disrupter, contributing to the development of metabolic diseases such as obesity and diabetes mellitus, which themselves are risk factors for cardiovascular disease. While the epidemiological evidence for the deleterious effects of PM air pollution on health is increasingly accepted, newer studies are shedding light on the mechanisms by which PM exerts its toxic effects. A greater understanding of how PM exerts toxic effects on human health is required in order to prevent and minimize the deleterious health effects of this ubiquitous environmental hazard. Air pollution is a growing public health problem and mortality due to air pollution is expected to double by 2050. Here, we review the epidemiological evidence for the cardiovascular effects of PM exposure and discuss current understanding about the biological mechanisms, by which PM exerts toxic effects on cardiovascular system to induce cardiovascular disease.

Analysis of Heterogeneous Gelation Dynamics and Their Application to Blood Coagulation

We present a scaling model based on a moving boundary picture to describe heterogeneous gelation dynamics. The dynamics of gelation induced by different gelation mechanisms is expressed by the scaled equation for the time taken for development of the gel layer with a few kinetic coefficients characterizing the system. The physical meaning obtained by the analysis for a simple boundary condition from the standpoint of the phase transition shows that the time development of the gelation layer depends on whether the dynamics of the order parameter expressing the gelation of the polymer solution is fast or slow compared with the diffusion of the gelators in the heterogeneous gelation. The analytical method is used to understand the coagulation of blood from various animals. An experiment using systems with plasma coagulation occurring at interfaces with calcium chloride solution and with packed erythrocytes is performed to provide the data for model fitting and it is clarified that a few key kinetic coefficients in plasma coagulation can be estimated from the analysis of gelation dynamics.

Predictive value of platelet aggregation rate in postpartum deep venous thrombosis and its possible mechanism

The present study investigated the predictive value of the platelet aggregation rate in postpartum deep venous thrombosis and its possible mechanism. From January 2014 to January 2016, 23 patients with postpartum deep vein thrombosis of lower extremity treated in the Department of Obstetrics of Beijing Chaoyang Hospital were as assigned as the observation group. At the same time, 25 cases with normal recovery were assigned as the control group. Blood samples were collected from all the subjects. The platelet aggregation rate was measured using a platelet aggregation apparatus. Plasma platelet activating factor (PAF) levels were measured by ELISA. The positive rate of platelet P-selectin (CD62p) and lysosomal membrane glycoprotein (CD63) was measured by flow cytometry. PI3K expression and AKt phosphorylation levels were measured by western blot analysis. The ROC curve was used to evaluate the value of the platelet aggregation rate in predicting postpartum deep vein thrombosis of lower extremity. The correlation between the platelet aggregation rate and PAF and PI3K/AKt expression was also analyzed. The cesarean section rate, platelet 5-min maximum aggregation rate, PAF level and the positive rate of CD62p and CD63 were significantly higher in the control than those in the observation group (P<0.05). Furthermore, the platelet aggregation rate was positively correlated with the expression of PAF, CD62p and CD63 (r=0.389, 0.451, and 0.452; all P<0.05). The platelet 5-min maximum aggregation rate for predicting postpartum deep vein thrombosis of lower extremity was reflected by the area under the ROC curve (AUC=0.797, P=0.000). The PI3Kp110β/β-actin and p-AKt/AKt ratio was significantly higher in the observation compared with the control group (P<0.05). In addition, the platelet aggregation rate was positively correlated with the expression of PI3K and phosphorylation level of AKt (r=0.441, 0.430; all P<0.05). The results suggested that platelet aggregation activity is elevated in postpartum deep vein thrombosis patients. It has a certain predictive value for the occurrence of postpartum deep vein thrombosis of lower extremity. Thuss, the PI3K/AKt signaling pathway may be one of the mechanisms of platelet aggregation.