Risk Assessment And Risk Factors Analysis Of Venous Thromboembolism In Patients With Rheumatoid Arthritis

Obejective:Recently a large number of studies have confirmed that the incidence of venous thromboembolism(VTE),deep venous thrombosis(DVT)and pulmonary embolism(PE)included,in patients with rheumatoid arthritis(RA)is significantly higher than that in patients without RA.This study assessed and compared the Padua thrombotic risk model score between RA and non RA patients,and assessed the risk factors and independent risk factors for increased VTE risk in RA patients.Methods:From January 1,2000 to January 31,2021,We selected patients with RA(n = 215,41 males and 174 females,age 16-75 years old)as experience group and Non RA patients(n = 203,91 males and 112 females,aged 16-75 years old)from the same database in the same period as control group by the means of simple random sampling,and the Padua model score and 11 indexes of Padua model of the two groups were compared.high-risk group(n = 22)and low-risk group(n = 193)of RA patients were distinguished according to Padua thrombus risk model score.The gender,smoking history,drinking history,hypertension history,diabetes history,varicose vein history,history of special medication(including anticoagulants or antiplatelet drug),RA duration,rheumatoid activity(DAS28-ESR score),rheumatoid treatment plan(whether to use Tofateb or not),rheumatoid complications,Barthel self-care ability assessment scale score,nursing dependence scale score,fasting blood glucose(FBG),cholesterol(CHO),triglyceride(TG),alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea(BUN),Creatinine(CREA),platelet count(PLT),platelet distribution width(PDW),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,antinuclear antibody titer(ANA antibody),antiphospholipid antibody titer(APS antibody),anti cyclic citrullinated peptide antibody(CCP antibody),interleukin 6(IL-6),interleukin 8(IL-8),interleukin 10(IL-10),Tumor Necrosis Factorα(TNF-α),Rheumatoid Factor(RF),Erythrocyte Sedimentation Rate(ESR),C Reaction Protein(CRP)of high-risk and low-risk groups were selected for analysis to search for the independent risk factors of VTE within RA patients.Results:(1)The average Padua model score of the experimental group was 1.900±1.324,and the average Padua model score of the control group was 0.830±1.311.There was a significant difference in Padua model score between two groups(P < 0.05).There were significant differences between two groups in the aspects including age(whether≥70 years old),acute infection and / or rheumatic disease,and currently receiving hormone therapy(P < 0.05 or P < 0.01).There were no significant differences in active cancer,past VTE history,decreased activity,known thrombophilia,mechanical trauma and / or surgery,heart and / or respiratory failure,acute heart infarction or ischemic brain stroke,obesity(BMI≥30)(P > 0.05).(2)The differences of gender,smoking history,drinking history,hypertension history,varicose vein history,special medication history(including anticoagulants or antiplatelet drug),rheumatoid treatment plan(whether to use Tofateb or not),complications,FBG,CHO,TG,ALT,AST,BUN,CREA,PLT,PDW,PT,APTT,D-dimer,ANA antibody,CCP antibody,IL-8,IL-10,TNF-α,Barthel self-care ability assessment scale score between high-risk group and low-risk group were not statistically significant;There was significant difference in diabete history,RA course,DAS28-ESR score,interleukin-6,RF,CRP,ESR,nursing dependence scale score between the two groups(P < 0.05 or P< 0.01).(3)After excluding confounding factors,RF and CRP level were independent risk factors for VTE in RA patients(odds ratio : 1.017,1.189,95% confidence interval:1.001～1.033,1.085～1.093,P < 0.05 or P < 0.01).Conclusion:(1)the risk of VTE in RA patients is higher than that in non RA patients.(2)diabete history,RA course,DAS28-ESR score,interleukin-6,RF,CRP,ESR,nursing dependence scale score were risk factors of VTE in RA patients.Gender,smoking history,drinking history,hypertension history,varicose vein history,special medication history(including anticoagulants or antiplatelet drug),rheumatoid treatment plan(whether to use Tofateb or not),complications,FBG,CHO,TG,ALT,AST,BUN,CREA,PLT,PDW,PT,APTT,D-dimer,ANA antibody,CCP antibody,IL-8,IL-10,TNF-α,Barthel self-care ability assessment scale score weren’t risk factors of VTE in RA patients.(3)RF and CRP level were independent risk factors for VTE in RA patients.