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Blood, 1 August 2007, Vol. 110, No. 3, pp. 908-912.
Prepublished online as a Blood First Edition Paper on April 4, 2007; DOI 10.1182/blood-2006-11-057604.


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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY

Sickle cell trait and the risk of venous thromboembolism among blacks

Harland Austin1, Nigel S. Key2, Jane M. Benson3, Cathy Lally1, Nicole F. Dowling3, Carolyn Whitsett4, and W. Craig Hooper3

1 Emory University, Rollins School of Public Health, Atlanta, GA; 2 University of North Carolina, Chapel Hill; 3 Division of Hereditary Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA; 4 Emory University, School of Medicine, Atlanta, GA

People with sickle cell disease have a chronically activated coagulation system and display hemostatic perturbations, but it is unknown whether they experience an increased risk of venous thromboembolism. We conducted a case–control study of venous thromboembolism that included 515 hospitalized black patients and 555 black controls obtained from medical clinics. All subjects were assayed for hemoglobin S and hemoglobin C genotypes. The prevalence of the S allele was 0.070 and 0.032 for case patients and controls, respectively (P < .001). The odds that a patient had sickle cell trait were approximately twice that of a control, indicating that the risk of venous thromboembolism is increased approximately 2-fold among blacks with sickle cell trait compared with those with the wild-type genotype (odds ratio = 1.8 with 95% confidence interval, 1.2-2.9). The odds ratio for pulmonary embolism and sickle cell trait was higher, 3.9 (2.2-6.9). The prevalence of sickle cell disease was also increased among case patients compared with controls. We conclude that sickle cell trait is a risk factor for venous thromboembolism and that the proportion of venous thromboembolism among blacks attributable to the mutation is approximately 7%.


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