Background Systemic sclerosis (SSc) is characterized endothelial dysfunction and vasculopathy, which may result in thrombosis. Venous thromboembolism (VTE) is a vascular phenomenon that includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
Objectives To evaluate the epidemiology of VTE in SSc, specifically cumulative incidence, risk factors and impact of VTE on survival.
Methods We conducted a cohort study of patients who fulfilled the ACR–EULAR classification criteria for SSc attending the Toronto Scleroderma Program 1970–2017. DVT was defined as the presence of thrombus on doppler ultrasound of either upper or lower extremity. PE was defined as the presence of thrombus on CT angiogram of the thorax. Time to all-cause mortality was evaluated in Kaplan Meier and Cox models.
Results 1181 subjects (971 (82%) female, 210 (18%) male) were included. There were 40 (3.4%) VTE events. The cumulative incidence of VTE was 2.7 (95% CI 1.9, 3.7) per 1000 patient years. The presence of ILD, PAH, ScL70 antibody, anticardiolipin antibody, coronary artery disease, diabetes mellitus and PVD occurred more frequently in subjects who developed VTE.
On multivariate logistic regression PAH (OR 3.77 (96%CI 1.83, 8.17), ScL70 antibodies (OR 2.45 95% CI 1.07, 5.30), anticardiolipin antibodies (OR 5.70 (95% CI 1.16, 21.2) and PVD (OR 5.31 (95% CI 1.99, 12.92) were independent predictors of VTE. Subjects with ILD more frequently experienced DVT (RR 2.85 95% CI (1.08, 7.54) but not PE (RR 1.82 (95% CI 0.89, 3.70). There were 440 deaths. There was no significant difference in survival between those with and without VTE (HR 1.6 (95% CI 0.70, 1.92). Only the presence of ILD (HR 1.54 (95% CI 1.27, 1.88) or PAH (HR 1.35 (95% CI 1.10, 1.65) remained independent predictors of mortality.
Conclusions The risk of VTE in SSc is not increased, as the incidence of VTE in SSc is comparable to the general population. The presence of PAH, PVD, ScL70 and anticardiolipin antibodies are risk factors for VTE in SSc. VTE does not independently affect SSc survival.
Acknowledgements Dr. Johnson is supported by the Canadian Institutes of Health Research.
Disclosure of Interest None declared