Risk of venous thromboembolism in patients with alpha-1 antitrypsin deficiency in the united states, 2016-2019

SESSION TITLE: Novel Considerations in COPD and Asthma Management SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Alpha-1 antitrypsin deficiency (AATD) is a genetic disease commonly affecting the lungs and leading to early-onset emphysema. AATD is inherited by autosomal co-dominated transmission. In severe cases where patients are homozygous for the Z allele (phenotype PiZZ), liver disease can also occur, leading to liver cirrhosis or hepatocellular carcinoma. Our study aims to determine whether patients with AATD have a higher likelihood of experiencing venous thromboembolism (VTE). METHODS: A retrospective study was conducted utilizing the Nationwide Inpatient Sample (NIS) database for the years 2016-2019. Patients with AATD and venous thromboembolism (VTE) were identified using the International Classification of Diseases (ICD-10) diagnosis codes from all listed discharge diagnoses. Patients with the diagnosis of COPD, emphysema, or cirrhosis were excluded. In addition, patients younger than 18 years of age, admitted for elective reasons, or missing information for age, gender, or race were excluded. Multivariate logistic regression analysis was performed using STATA 17. RESULTS: We included 19,115 patients who were hospitalized and had AATD and compared them to other hospitalized patients who did not have the diagnosis of AATD. Adult patients who were admitted to the hospitals with AATD were found to have 25% higher odds of VTE than patients who didn’t have AATD (Odds Ratio= 1.25, 95% CI: 1.03-1.52, P value 0.022). Patients aged >=65 were also associated with higher odds of thrombosis compared to patients aged less than 65 years (Odds Ratio= 1.23, 95% CI: 1.22-1.24, P value <0.00). Females were less likely to develop VTE than males (Odds Ratio= 0.88, 95% CI: 0.87-0.89, P value <0.00). Compared to the white race, Hispanic, Asian/Pacific Islander, Native American, and other races had lower odds of developing VTE (Odds Ratio = 0.66, 0.47, 0.72, and 0.82 respectively, CI: 0.65-0.67, 0.45-0.49, 0.69-0.76, and 0.78-0.86 respectively, all P values were < 0.00), except for the African American race which was found to have higher odds of developing VTE (Odds Ratio = 1.14, 95% CI: 1.13-1.15, P value < 0.00). CONCLUSIONS: The findings of our study indicate that individuals with AATD are at a greater risk of developing VTE during their hospital stay. However, the precise mechanism underlying this association has yet to be fully elucidated. One hypothesis is that there may be an upregulation in the proteolytic activity of the plasminogen activator, which can potentially trigger the coagulation cascade. VTE is a significant cause for concern, given its potential to result in substantial morbidity and mortality. CLINICAL IMPLICATIONS: In patients diagnosed with AATD, physicians should be vigilant for the possibility of VTE in relevant clinical contexts. Additionally, healthcare professionals should conduct a thorough evaluation of AATD patients for other VTE risk factors. Various studies have demonstrated a correlation between Alpha-1 antitrypsin ZZ homozygosity and an increased risk of VTE, but further research is necessary to assess the risk in individuals with different phenotypes of AATD. DISCLOSURES: No disclosure on file for Ahmad Albalbissi No relevant relationships by Mohammad Darweesh No relevant relationships by Amira Eftaiha No relevant relationships by Suhib Fahmawi No relevant relationships by Ahmad Othman