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The CHA 2 DS 2 -VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA 2 DS 2 -VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA 2 DS 2 -VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA 2 DS 2 -VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA 2 DS 2 -VASc scores. However, in individuals with CHA 2 DS 2 -VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA 2 DS 2 -VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA 2 DS 2 -VASc scores ≥5. These findings should be confirmed in clinical trials., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Vaginal bleeding in early pregnancy is not associated with a higher cancer risk compared with pregnancies in women from the general population of similar age.

Background: Retinal vein thrombosis has in case reports been reported a clinical sign of cancer, especially hematological cancer. However, it is unclear whether retinal vein thrombosis is a marker of underlying cancer, as is the case for deep venous thrombosis and pulmonary embolism. We investigated the risk of occult cancer in patients with retinal vein thrombosis., Methods: A nationwide population-based cohort study in Denmark on all patients diagnosed with a retinal vein thrombosis during 1994 and 2013. The main outcome measures were any cancer and site-specific cancers <6 months, 6-12 months, and 5 years following a retinal vein thrombosis diagnosis, as registered in the Danish Cancer Registry and the National Pathology Registry. We calculated the absolute cancer risk and computed standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) for cancer within <6 months, 6-12 months, and 5 years following a retinal vein thrombosis diagnosis., Results: Among 9589 patients with retinal vein thrombosis, we observed 1514 cancer cases. The risk of any cancer was 1.2% <6 months and 28.8% after 5 years. The <6 months SIR was 1.20 (95% CI 0.99-1.44), 6-12 months SIR was 1.15 (95% CI 0.94-1.39), and the 5 years' SIR was 1.08 (95% CI 1.03-1.14). Stratification by age, gender, calendar year, and Charlson Comorbidity Index score did not change overall cancer risk estimates., Conclusion: Retinal vein thrombosis was not an important clinical marker for occult cancer. An extensive diagnostic cancer workup does not appear warranted for retinal vein thrombosis patients., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Valid estimation of the incidence and risk factors for venous thromboembolism (VTE) among lymphoma patients has been limited by small studies focused on selected lymphoma subtypes and failure to account for death as a competing risk. Using a nationwide cohort of Danish lymphoma patients diagnosed from 2000 to 2010, we examined the incidence and risk factors for VTE and evaluated the transient impact of cancer treatments on VTE risk., Methods: Medical databases contained cancer, comorbidity, treatment, and VTE information. We computed VTE incidence rates (IRs) per 1000 person-years and 1- and 2-year incidence accounting for competing risks. Using Cox proportional hazards models, we identified factors associated with VTE risk. In a nested self-controlled design, we evaluated the transient effect of chemotherapy, radiation, central venous catheter use and rituximab on VTE risk using logistic regression models and adjusted odds ratios (aORs)., Results: VTE IRs were >40/1000 person-years within 180 days post-diagnosis, decreasing to 8/1000 person-years in year two. VTE risk was 2.9% and 3.5% at 1 and 2 years, respectively. Lymphoma subtype, central nervous system involvement, and elevated lactate dehydrogenase were associated with VTE risk. Central venous catheter use increased the transient odds of VTE (aOR=6.7 (1.2, 28.1))., Conclusions: We report a lower VTE incidence among lymphoma patients compared with prior studies. Lymphoma aggressiveness was the main driver of baseline VTE risk, whereas central venous catheter use increased transient risks. These accurate estimates may improve the identification of lymphoma subgroups at highest VTE risk, for whom future targeted prevention interventions may be beneficial., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: Patients with acute myocardial infarction or stroke are at high risk of venous thromboembolism, which is traditionally considered a complication rather than a marker of occult cancer. We examined the association between venous thromboembolism and cancer in patients with acute myocardial infarction or stroke., Methods: We used medical databases to conduct a population-based cohort study including all patients with a first-time venous thromboembolism from 1978 through 2011 who also had a diagnosis of acute myocardial infarction (n=2,878) or stroke (n=1,971) recorded on the same day or within the previous 90days. We followed patients until a first-time cancer diagnosis, emigration, death, or December 31, 2011, whichever came first. We computed 1-year absolute risks and standardised incidence ratios for cancer based on national incidence rates., Results: The 1-year absolute cancer risk was 2.7% in the acute myocardial infarction cohort and 3.7% in the stroke cohort. The corresponding standardised incidence ratios were 3.22 (95% confidence interval [CI]: 2.54-4.03) and 3.76 (95% CI: 2.95-4.74), respectively. For cancers diagnosed in the first year, the estimated number of venous thromboembolism patients needed to examine to detect one excess cancer was 25 in the acute myocardial infarction cohort and 19 in the stroke cohort., Conclusion: Among acute myocardial infarction and stroke patients, venous thromboembolism can be a marker of occult cancer. We suggest that current guidelines for cancer screening in patients with unprovoked venous thromboembolism could be applied to this group of patients., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Heart diseases increase the risk of arterial embolism; whether they increase the risk of pulmonary embolism without peripheral venous thrombosis is less certain., Methods and Results: We conducted a nationwide, population-based case-control study in Denmark using patients diagnosed with pulmonary embolism and/or deep venous thrombosis between 1980 and 2007. We computed odds ratios to estimate relative risks associating preceding heart disease with pulmonary embolism, pulmonary embolism and deep venous thrombosis, or deep venous thrombosis alone. In this study, 45,282 patients had pulmonary embolism alone, 4680 had pulmonary embolism and deep venous thrombosis, and 59,790 had deep venous thrombosis alone; 541,561 were population controls. Myocardial infarction and heart failure in the preceding 3 months conferred high risks of apparently isolated pulmonary embolism (odds ratio, 43.5 [95% confidence interval (CI), 39.6-47.8] and 32.4 [95% CI, 29.8-35.2], respectively), whereas the risks of combined pulmonary embolism and deep venous thrombosis (19.7 [95% CI, 16.0-24.2] and 22.1 [95% CI, 18.7-26.0], respectively) and deep venous thrombosis alone (9.6 [95% CI, 8.6-10.7] and 12.7 [95% CI, 11.6-13.9], respectively) were lower. Left-sided valvular disease was associated with an odds ratio of 13.5 (95% CI, 11.3-16.1), whereas the odds ratio was 74.6 (95% CI, 28.4-195.8) for right-sided valvular disease. Restricting the analysis to cases diagnosed after 2000 led to lower risk estimates but the same overall pattern., Conclusion: Heart diseases increase the near-term risk for pulmonary embolism not associated with diagnosed peripheral vein thrombosis.

Background: Venous thromboembolism is a predictor of subsequent risk of ischemic stroke and intracerebral hemorrhage, but no data are available regarding its association with risk of subarachnoid hemorrhage., Objectives: To examine this issue, we conducted a nationwide cohort study in Denmark., Patients and Methods: Between 1977 and 2007, we identified 97,558 patients with a hospital diagnosis of venous thromboembolism and obtained information on risk of subsequent subarachnoid hemorrhage during follow-up in the Danish Registry of Patients. The incidence of subarachnoid hemorrhage in the venous thromboembolism cohort was compared with that of 453,406 population control cohort members., Results: For patients with pulmonary embolism (PE), there was clearly an increased risk of subarachnoid hemorrhage, both during the first year of follow-up [relative risk 2.69; 95% confidence interval (CI), 1.32-5.48] and during later follow-up of 2-20 years (relative risk 1.40; 95% CI, 1.05-1.87). For patients with deep venous thrombosis (DVT) the risk was likewise clearly increased during the first year of follow-up (relative risk 1.91; 95% CI, 1.13-3.22), but not during later follow-up (relative risk 1.04; 95% CI, 0.81-1.32)., Conclusions: We found evidence that PE is associated with an increased long-term risk of subarachnoid hemorrhage. The two diseases might share etiologic pathways affecting the vessel wall or share unknown risk factors., (© 2010 International Society on Thrombosis and Haemostasis.)

Background: In some studies, venous thromboembolism has been associated with atherosclerosis and with the risk of arterial cardiovascular events such as myocardial infarction and stroke. Other studies, however, do not show this association. To help clarify these discrepant findings, we aimed to investigate the risk of arterial cardiovascular events in patients who were diagnosed with venous thromboembolism., Methods: We undertook a 20-year population-based cohort study using data from nationwide Danish medical databases. After excluding those with known cardiovascular disease, we assessed the risk of myocardial infarction and stroke in 25,199 patients with deep venous thrombosis, 16,925 patients with pulmonary embolism, and 163,566 population controls., Findings: For patients with deep venous thrombosis, the relative risks varied from 1.60 for myocardial infarction (95% CI 1.35-1.91) to 2.19 (1.85-2.60) for stroke in the first year after the thrombotic event. For patients with pulmonary embolism, the relative risks in that year were 2.60 (2.14-3.14) for myocardial infarction and 2.93 (2.34-3.66) for stroke. The relative risks were also raised, though less markedly, during the subsequent 20 years of follow-up, with 20-40% increases in risk for arterial cardiovascular events. Relative risks were similar for those with provoked and unprovoked deep venous thrombosis and pulmonary embolism., Interpretation: Patients with venous thromboembolism have a substantially increased long-term risk of subsequent arterial cardiovascular events.