Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use
Article first published online: 28 AUG 2007
Copyright © 2007 Wiley-Liss, Inc.
American Journal of Hematology
Volume 83, Issue 2, pages 97–102, February 2008
How to Cite
Pomp, E. R., Rosendaal, F. R. and Doggen, C. J.M. (2008), Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am. J. Hematol., 83: 97–102. doi: 10.1002/ajh.21059
- Issue published online: 2 JAN 2008
- Article first published online: 28 AUG 2007
- Manuscript Revised: 23 JUL 2007
- Manuscript Accepted: 23 JUL 2007
- Manuscript Received: 14 JUL 2007
- Netherlands Heart Foundation. Grant Number: NHS 98.113
- Dutch Cancer Foundation. Grant Number: RUL 99/1992
- Netherlands Organisation for Scientific Research. Grant Number: 912-03-033|2003
The results of studies investigating the relationship of smoking with venous thrombosis are inconsistent. Therefore, in the MEGA study, a large population-based case–control study, we evaluated smoking as a risk factor for venous thrombosis and the joint effect with oral contraceptive use and the factor V Leiden mutation. Consecutive patients with a first venous thrombosis were included from six anticoagulation clinics. Partners of patients were asked to participate and additional controls were recruited using a random digit dialing method. Participants completed a standardized questionnaire. Individuals with known malignancies were excluded from the analyses, leaving a total of 3,989 patients and 4,900 controls. Current and former smoking resulted in a moderately increased risk of venous thrombosis (odds ratio (OR)current 1.43, 95% confidence interval (CI95) 1.28–1.60, ORformer 1.23, CI95 1.09–1.38) compared with nonsmoking. Adjustment for fibrinogen levels did not substantially change these risk estimates. A high number of pack-years resulted in the highest risk among young current smokers (OR≥20 pack-years 4.30, CI95 2.59–7.14) compared with young nonsmokers. Women who were current smokers and used oral contraceptives had an 8.8-fold higher risk (OR 8.79, CI95 5.73–13.49) than nonsmoking women who did not use oral contraceptives. Relative to nonsmoking noncarriers, the joint effect of factor V Leiden and current smoking led to a 5.0-fold increased risk; for the prothrombin 20210A mutation this was a 6.0-fold increased risk. In conclusion, smoking appears to be a risk factor for venous thrombosis with the greatest relative effect among young women using oral contraceptives. Am. J. Hematol., 2008. © 2007 Wiley-Liss, Inc.