| 1. |
- Bergh, N., et al.
(författare)
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Influence of TNF-α and biomechanical stress on endothelial anti- and prothrombotic genes
- 2009
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Ingår i: Biochemical and Biophysical Research Communications. - : Elsevier BV. - 0006-291X .- 1090-2104. ; 385, s. 314-318
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Tidskriftsartikel (refereegranskat)abstract
- Biomechanical stress modulates vascular tone, vascular remodelling and the spatial localisation of atherosclerotic plaques. Inflammatory cytokines, such as TNF-α, regulate expression of genes that impair the function of endothelial cells. This study investigates the combinatory effect of different biomechanical stresses and TNF-α on the expression of endothelial anti- and prothrombotic genes. Human umbilical vein endothelial cells were exposed to TNF-α and different levels of static/pulsatile tensile stress or shear stress. The response in endothelial cells to TNF-α was not modulated by tensile stress. However, shear stress was a more potent stimulus. Shear stress counteracted the cytokine-induced expression of VCAM-1, and the cytokine-suppressed expression of thrombomodulin and eNOS. Shear stress and TNF-α additively induced PAI-1, whereas shear stress blocked the cytokine effect on t-PA and u-PA. A flow profile characterized by high laminar shear stress seems to render the endothelial cell more resistant to inflammatory stress. © 2009 Elsevier Inc. All rights reserved.
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| 2. |
- Glise Sandblad, Katarina, 1982, et al.
(författare)
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Association of type of oral anticoagulation with risk of bleeding in 45,114 patients with venous thromboembolism during initial and extended treatment-A nationwide register-based study.
- 2023
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Ingår i: Journal of internal medicine. - 1365-2796. ; 294:6, s. 743-60
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Tidskriftsartikel (refereegranskat)abstract
- Safety data for different anticoagulant medications in venous thromboembolism (VTE) are scarce, in particular for extended treatment.To compare major bleeding rates depending on the choice of anticoagulation during initial (first 6 months) and extended treatment (6 months up to 5 years).A nationwide register-based study including cancer-free patients with a first-time VTE between 2014 and 2020. Cox proportional hazards models were used to compare bleeding rates.We included 6558 patients on warfarin, 18,196 on rivaroxaban, and 19,498 on apixaban. At 6 months, 4750 (72.4%) remained on warfarin, 11,366 (62.5%) on rivaroxaban, and 11,940 (61.2%) on apixaban. During initial treatment, major bleeding rates were 3.86 (95% CI 3.14-4.58), 2.93 (2.55-3.31), and 1.95 (1.65-2.25) per 100 patient-years for warfarin, rivaroxaban, and apixaban, respectively, yielding adjusted hazard ratios (aHRs) of 0.89 (95% CI 0.71-1.12) for rivaroxaban versus warfarin, 0.55 (0.43-0.71) for apixaban versus warfarin, and 0.62 (0.50-0.76) for apixaban versus rivaroxaban. During extended treatment, major bleeding rates were 1.55 (1.19-1.91), 1.05 (0.85-1.26), and 0.96 (0.78-1.15) per 100 patient-years for warfarin, rivaroxaban, and apixaban, respectively, with aHRs of 0.72 (0.53-0.99) for rivaroxaban versus warfarin, 0.60 (0.44-0.82) for apixaban versus warfarin, and 0.85 (0.64-1.12) for apixaban versus rivaroxaban. Previous bleeding and increasing age were risk factors for bleeding both during initial and extended treatment.Apixaban had a lower bleeding risk than warfarin or rivaroxaban during initial treatment. During extended treatment, bleeding risk was similar for apixaban and rivaroxaban, and higher with warfarin.
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| 3. |
- Glise Sandblad, Katarina, 1982, et al.
(författare)
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Obesity in adolescent men increases the risk of venous thromboembolism in adult life
- 2020
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 287:6, s. 734-745
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Tidskriftsartikel (refereegranskat)abstract
- Background: As the population of obese and severely obese young adults grows, it is becoming increasingly important to recognize the long-term risks associated with adolescent obesity. Objectives: This study aimed to determine the association between body mass index (BMI) in young men at enlistment for military service and later risk of venous thromboembolism (VTE). Methods: Nationwide register-based prospective cohort study of men enlisting 1969 to 2005, followed through the Swedish National Patient and Cause of Death registries. We identified 1639838 men (mean age, 18.3years) free of prior venous thromboembolism, of whom 29342were obese (BMI 30 to <35kgm−2) and 7236 severely obese (BMI≥35kgm−2). The participants were followed until a first registered diagnosis of VTE. Results: During a median follow-up of 28years (interquartile interval, 20 to 36years), 11395 cases of deep vein thrombosis and 7270 cases of pulmonary embolism were recorded. Compared with men with a BMI of 18.5 to <20kgm−2, men with higher BMI in young adulthood showed an incrementally increasing risk of VTE that was moderately but significantly increased already at normal BMI levels. Adolescent obese men with a BMI of 30 to 35kgm−2 had an adjusted hazard ratio of 2.93 (95% confidence interval, 2.65 to 3.24) for VTE. Severely obese men with a BMI of ≥35kgm−2 had a hazard ratio of 4.95 (95% confidence interval, 4.16 to 5.90). Conclusions: Men who were obese or severely obese in young adulthood had a marked increase in risk of VTE.
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| 4. |
- Glise Sandblad, Katarina, 1982, et al.
(författare)
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Prevalence of Cancer in Patients with Venous Thromboembolism: A Retrospective Nationwide Case-Control Study in Sweden.
- 2023
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Ingår i: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. - : SAGE Publications. - 1938-2723. ; 29
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Tidskriftsartikel (refereegranskat)abstract
- Cancer is a risk factor for venous thromboembolism (VTE). We aimed to define sex-specific risk of preceding cancer in patients with a first-time VTE by conducting a nationwide Swedish registry-based study including 298172 patients with VTE and 1185079 matched controls. This included 44685 patients with a diagnosis of cancer at/or within 1 year before a VTE diagnosis. Female patients with VTE had a higher multivariable adjusted odds ratios of preceding cancer than male patients with VTE (5.5 [99% confidence interval 5.4-5.7] vs 3.9 [3.8-4.0]). The highest risk of cancer in patients with VTE were found for pancreatic cancer (women: 19.6 [15.8-24.4]; men: 17.2 [13.7-21.6]) and brain cancer (women: 17.4 [12.9-23.4]; men: 17.5 [13.8-22.2]). Weak associations were seen between VTE and bladder/urothelial cancer (women: 1.31 [1.12-1.53]; men: 1.34 [1.23-1.47]), prostate cancer (men: 2.17 [2.07-2.27]), malignant melanoma (women: 2.51 [2.07-3.05]; men: 2.67 [2.23-3.18]), and kidney cancer (women: 3.20 [2.49-4.11]; men: 3.33 [2.79-4.07]). In conclusion, associations with VTE were weak for bladder/urothelial cancer and kidney cancer, and strong for pancreatic, brain, and biliary cancers.
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| 5. |
- Glise Sandblad, Katarina, 1982, et al.
(författare)
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Pulmonary embolism and deep vein thrombosis-comorbidities and temporary provoking factors in a register-based study of 1.48 million people.
- 2022
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Ingår i: Research and practice in thrombosis and haemostasis. - : Elsevier BV. - 2475-0379. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge on differences in patients who present with deep vein thrombosis (DVT) and those with pulmonary embolism (PE) is incomplete.To determine comorbidities and temporary provoking factors in patients with a first-time PE or DVT.This was a nationwide Swedish registry-based, retrospective, case-control study including 298172 patients with first-time venous thromboembolism (VTE) and 1185079 controls matched for age, sex, and county of residence, free of VTE at the time of matching.Patients with PE were older than those with DVT (mean age, 69 vs 66years) and included slightly more women (PE, 53.4% vs DVT, 52.1%). After multivariable adjustment for comorbidities (within 7years) and temporary provoking factors (within 3months), heart failure (PE: adjusted odds ratio [aOR], 2.64 [99% confidence interval [CI], 2.55-2.73]; DVT: aOR, 1.66 [99% CI, 1.60-1.72]), ischemic heart disease (PE: aOR, 1.51 [99% CI, 1.47-1.56]; DVT: aOR, 1.01 [99% CI, 0.98-1.04]), and chronic obstructive pulmonary disease (PE: aOR, 2.51 [99% CI, 2.40-2.63]; DVT, 1.54 [99% CI, 1.47-1.62]) were among diseases that showed higher odds ratios in patients with PE than in those with DVT, compared with controls. Comorbidities registered within 6months were associated with higher aORs than those within 7years. The highest population attributable risks for PE were for cancer (13.0%) and heart failure (11.7%).Cardiopulmonary diseases, particularly with recent onset, imply a higher risk for PE, whereas orthopedic surgery and lower-extremity fractures carry a higher risk of DVT.
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| 6. |
- Glise Sandblad, Katarina, 1982
(författare)
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Venous thromboembolism: Risk factors, comorbidities, and treatment-associated risk of bleedings
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Venous thromboembolism (VTE) is the third most common cardiovascular disease, consisting mainly of deep vein thrombosis (DVT) and pulmonary embolism (PE). Since VTE often is a preventable disease, knowledge of risk factors is critical. Following a VTE, many patients are subjected to extended anticoagulant treatment. However, the bleeding risk during extended treatment is largely unknown. Aim: To study risk factors in patients with VTE and to determine the occurrence of major bleeding during VTE treatment. Methods: Paper I: 1.6 million men from The Swedish Military Service Conscription Register were grouped based on BMI and followed through nationwide registries to determine the risk of a first-time VTE. Papers II-IV: The National Patient Register, the National Cause of Death Register, the National Prescribed Drug Register, and the Total Population Register were used to identify almost 300,000 patients with first-time PE or DVT and 1,200,000 matched controls. PE and DVT patients and their respective controls were compared regarding comorbidities and temporary provoking factors (II), the prevalence of different cancers (III), and, between 2014– 2020, the risk of bleeding during anticoagulant treatment (IV). Results: Paper I: Men who were overweight or obese at enlistment had a high risk of VTE later in life. Paper II: Patients with PE more often had underlying cardiovascular disease, while patients with DVT were more likely to have recent musculoskeletal surgery or fracture. Paper III: VTE had a strong association with pancreatic, brain, or liver cancer, while the association was weak with recent diagnoses of bladder/urinary tract cancer, kidney cancer, or uterine cancer. Paper IV: During initial treatment (0–6 months), patients treated with apixaban had a lower bleeding risk than patients treated with warfarin or rivaroxaban. During extended treatment (6 months–5 years), both apixaban and rivaroxaban had a low bleeding risk, lower than warfarin. Conclusion: The increasing prevalence of obesity might imply an increase in VTE in the coming decades. Patients with cardiopulmonary disease had a higher risk of PE than DVT. Risks of VTE differ widely for various cancers. Apixaban carried a lower risk of bleeding than rivaroxaban and warfarin in the initial treatment, while both apixaban and rivaroxaban had a low risk of bleeding, and lower than warfarin, in extended treatment. These findings are important for VTE prophylaxis and treatment in clinical praxis.
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| 7. |
- Mahmoud, Ahmad, et al.
(författare)
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Prepregnancy overweight and obesity and long-term risk of venous thromboembolism in women.
- 2023
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Ingår i: Scientific reports. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Overweight and obesity rates have increased in recent decades, particularly among the younger population. The long-term consequences of obesity with respect to early venous thromboembolism (VTE) in women have not been established. The aimwas to investigate the association between body mass index (BMI) in early pregnancy as a proxy for non-pregnant weight and long-term post-pregnancy risk of VTE in women. This registry-based prospective cohort study analysed data from the Swedish Medical Birth Registry, linked to the National Patient and the National Cause of Death Registries for information on post-pregnancy long-term risk of VTE. Cox proportional hazards model were used to determine the association between BMI at baseline and VTE events during follow-up starting 1 year after baseline. The mean age at registration was 27.5 (standard deviation, 4.9) years. During a median follow-up duration of 12years (interquartile range, 6-21years) starting 1 year after the first antenatal visit, 1765 and 2549 women had a deep vein thrombosis and/or pulmonary embolism. The risk of VTE linearly increased with increasing BMI. Compared to women with 20≤BMI<22.5kg/m2, women with high normal weight, i.e. with a BMI of 22.5-25.0kg/m2, had an adjusted hazard ratio (HR) of 1.30 (95% confidence interval [CI] 1.19-1.41), whereas those with a BMI of 30-35kg/m2 and≥35kg/m2 (severe obesity) had an adjusted HR of 2.35 (95% CI 2.04-2.70) and 3.47 (95% CI 2.82-4.25, respectively. Using BMI in early pregnancy as a proxy for pre-pregnancy or non-pregnant BMI in young women, we found a significantly increased risk of post-pregnancy long-term risk of VTE even in those with high normal BMI, compared with lean women, whereas those with severe obesity had a markedly high risk.
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| 8. |
- Sjöland, Helen, 1959, et al.
(författare)
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Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study
- 2023
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Ingår i: Research and Practice in Thrombosis and Haemostasis. - 2475-0379. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and & GE;180 days. Cox regression was used for evalu-ation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (& GE;180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.
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