Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Adulthood atopic dermatitis (AD) was significantly associated with an increased risk of venous thromboembolism (VTE); however, the absolute risk was small.

2. Vascular examination and consultation involving various specialties (e.g., emergency department, cardiologists, pulmonologists, etc.) are indicated for patients with AD experiencing common VTE symptoms (e.g., unexplained dyspnea, chest tightness, and limb swelling).

Evidence Rating Level: 2 (Good)

Study Rundown:

Atopic dermatitis (AD) is a chronic immune-mediated inflammatory skin condition. AD is associated with sleep disturbances, increased risk of cardiovascular disease, and an overall decreased quality of life. Venous thromboembolism (VTE) is a vascular disease comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE). Both AD and VTE result in patients having high levels of inflammatory and prothrombotic markers. Despite this similarity, seldom studies have investigated the association between AD and VTE in adulthood. Therefore, this retrospective study aimed to evaluate the risk of VTE among patients with AD. The absolute risk difference of VTE between adults with and without AD was small; however, AD in adulthood was found to have a significantly increased risk of incident DVT, PE, and VTE. A strength of this study is the large nationwide database. A limitation of this study includes the lack of comorbidity, lifestyle factor, and laboratory result analyses. Other potential limitations include ICD misclassification, the use of non-valid measures to assess AD severity, and the exclusion of persistent AD.

In-Depth [retrospective cohort]:

All data for this nationwide retrospective cohort study was derived from Taiwan’s National Health Insurance Research Database (NHIRD), which encompasses approximately 23.6 million patient health records. Patients were included in the exposed (AD) cohort if they were 20 years or older, within the NHIRD between January 1, 2003, and December 31, 2017, and diagnosed with AD by a dermatologist or rheumatologist. A diagnosis of AD was defined by 3 or more outpatient appointments concerning AD within 1 year or a discharge diagnosis using ICD-9-CM code 691.8 and ICD-10-CM code L20. Patients were included in the unexposed (non-AD) cohort if they were in NHIRD, 20 years or older, and did not have an AD diagnosis between 2000 and 2018. Each patient with AD was randomly matched with a control patient from NHIRD based on matching age, sex, and index date. Exclusion criteria included any AD diagnoses before 2003 and patients with any record of VTE before the index date. Hazard ratios (HR) for incident VTE associated with AD, the main outcome of this study, were evaluated using Cox proportional hazard models. In total, 284,858 patients were included in this study, with 142,429 in the AD group (mean [SD] age, 44.9 [18.3] years; 78,213 women) and 142,429 in the non-AD group (mean [SD] age, 44.1 [18.1] years; 79,636 women). More patients in the AD group developed VTE compared to the non-AD group (0.7% and 0.6%, respectively). Furthermore, adults with AD had significantly increased incident VTE risk (HR, 1.28; 95% Cl, 1.17-1.40) compared to adults without AD. AD patients were also found to have higher risks of DVT (HR, 1.26; 95% Cl, 1.14-1.40) and PE (HR, 1.30; 95% Cl, 1.08-1.57), which both comprise VTE. Although the absolute risk difference of VTE between adults with and without AD was small, this study found an association between AD in adulthood and an increased risk of VTE.

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