Evaluation of Risk Factors Associated with Venous Thromboembolism in the Lebanese Population

Background: Venous thromboembolism (VTE) is a multifactorial disease with a preventable characteristic. The knowledge of its predictive risk factors will help in preventing it. Therefore, the aim of this study is to assess the predictive risk factors of VTE in the Lebanese population so that effective recommendations can be drawn out.

Methodology: A retrospective case-control study was carried between the periods of March till June 2017 in two tertiary care hospitals in Beirut-Lebanon. Patients with a confirmed official diagnosis of VTE between the period going from 2008 till 2016 were taken as cases. Each case was randomly matched with 2 hospitalized controls. Questionnaires concerning VTE risk factors and symptoms were filled. Data were then entered into SPSS version 21 to explore the association between the risk factors and VTE. Bi-variate and multivariate logistic regression were done and a p-value less than 0.05 was considered.

Results: 430 patients were included in our study. Among these, 140 were cases of deep vein thrombosis and/or pulmonary embolism and 290 were matched controls. The results of the bi-variate analysis was significant for history of VTE, active cancer, general surgery, thrombophilia, immobility, active/recent pneumonia, trauma, and hormone replacement therapy/contraceptives use (p-value<0.001). It was also significant for history of coronary artery disease/myocardial infarction (p-value=0.018), neurological disease (p-value=0.001), stroke (p-value=0.033) liver diseases and varicose veins (p-value=0.045) and spinal cord injury (p-value=0.034). In multivariate analysis, the probability of VTE was significant for: VTE history (OR=32.8; p-value<0.001), thrombophilia (OR=25.4; p-value<0.001), major trauma (OR=11.5; p-value<0.001), general surgery (OR=10.2; p-value<0.001), immobility (OR=6.9; p-value=0.003), history of stroke (OR=6.8; p-value=0.001), serious liver disease (OR=6.5; p-value=0.016), cancer (OR=5; p-value<0.001), central venous catheter or pacemaker implantation (OR=4.4; p-value=0.025), active/recent pneumonia (OR=3.2; p-value=0.023), neurological disorders (OR=3; p-value =0.047), coronary artery disease/myocardial infarction (OR=2.3; p-value=0.017) and chronic lung diseases (OR= 2.2; p-value=0.033). There was a lack of testing for thrombophilia in the Lebanese hospitals.

Conclusion: The knowledge of these causative risk factors and their influence on VTE is crucial to initiate awareness in the population and strict prophylactic procedures for hospitalized patients. Furthermore, physicians must be more aware of the possible thrombophilic factors behind VTE cases by searching through thrombophilia testing. Larger studies must be done to investigate risk factors not detected in this study in order to further generalize the results.