Depressive symptoms as a novel risk factor for recurrent venous thromboembolism: a longitudinal observational study in patients referred for thrombophilia investigation.

BACKGROUND Increasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE) against a background of genetic and acquired risk factors. The role of psychosocial factors for the risk of recurrent VTE has not previously been examined. We hypothesized that depressive symptoms in patients with prior VTE are associated with an increased risk of recurrent VTE. METHODS In this longitudinal observational study, we investigated 271 consecutive patients, aged 18 years or older, referred for thrombophilia investigation with an objectively diagnosed episode of VTE. Patients completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). During the observation period, they were contacted by phone and information on recurrent VTE, anticoagulation therapy, and thromboprophylaxis in risk situations was collected. RESULTS Clinically relevant depressive symptoms (HADS-D score ≥ 8) were present in 10% of patients. During a median observation period of 13 months (range 5-48), 27 (10%) patients experienced recurrent VTE. After controlling for sociodemographic and clinical factors, a 3-point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE (OR 1.44, 95% CI 1.02, 2.06). Compared to patients with lower levels of depressive symptoms (HADS-D score: range 0-2), those with higher levels (HADS-D score: range 3-16) had a 4.1-times greater risk of recurrent VTE (OR 4.07, 95% CI 1.55, 10.66). CONCLUSIONS The findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors. An increased risk might already be present at subclinical levels of depressive symptoms

Risk of recurrence of venous thromboembolism with depressive symptoms.

<p>Depressive symptoms were entered in steps of 3 points. The model accounted for 10.5% of the variance (chi square = 13.99, df = 5, p = 0.016).</p><p>Risk of recurrence of venous thromboembolism with depressive symptoms.</p

Flow chart of patient recruitment.

<p>Flow chart of patient recruitment.</p

Patient characteristics per recurrence of venous thromboembolism.

<p>OAC, oral anticoagulation; DVT, deep venous thrombosis; PE, pulmonary embolism; VTE, venous thromboembolism. Data are given as number of observations (n) and percentage of total (%) or median with interquartile range. P-values refer to group comparison.</p><p>Patient characteristics per recurrence of venous thromboembolism.</p