Cytomegalovirus-Associated Venous and Arterial Thrombotic Disease

Amar H Kelkar; Brian L Loc; Michael D Tarantino; Anita Rajasekhar; Huaping Wang; Mona Kelkar; John Farrell

doi:10.7759/cureus.12161

Cytomegalovirus-Associated Venous and Arterial Thrombotic Disease

Cureus. 2020 Dec 18;12(12):e12161. doi: 10.7759/cureus.12161.

Authors

Amar H Kelkar¹, Brian L Loc², Michael D Tarantino³, Anita Rajasekhar¹, Huaping Wang⁴, Mona Kelkar⁵, John Farrell⁶

Affiliations

¹ Division of Hematology & Oncology, University of Florida College of Medicine, Gainesville, USA.
² Department of Cardiology, OSF Saint Francis Medical Center, Peoria, USA.
³ Department of Hematology, Bleeding & Clotting Disorders Institute, Peoria, USA.
⁴ Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA.
⁵ Department of Biostatistics & Epidemiology, Harvard School of Public Health, Cambridge, USA.
⁶ Department of Microbiology & Immunology, OSF System Laboratory, Peoria, USA.

Abstract

Background: Cytomegalovirus (CMV) infection has been associated with venous thromboembolism (VTE) and acute coronary syndromes (ACS).

Methods: A retrospective study was conducted within the OSF HealthCare System in Peoria, IL. The objectives were to determine the incidence of acute VTE and ACS within one year of CMV testing. The "study group" included patients with positive CMV immunoglobulin M (IgM) or positive CMV polymerase chain reaction (PCR). The "seropositive control" group included patients with positive CMV immunoglobulin G (IgG) and negative IgM. The "seronegative control" group included patients with negative CMV IgG and IgM, or negative PCR.

Results: Within one year of CMV infection, 38 of 379 patients (10.0%) developed VTE in the study group compared to 41 of 1334 patients (3.1%) in the seropositive control and 37 of 1249 (3.0%) in the seronegative control. Adjusting for age and gender, both control groups were less likely to have VTE than the study group within one year (seropositive control: odds ratio (OR) = 0.3, 95% confidence interval (CI) 0.2-0.5, p < 0.0001; seronegative control: OR = 0.4, 95% CI 0.2-0.6, p < 0.0001). ACS was more likely to occur in the study group, with the incidence of 7.7% compared to 4.7% (p < 0.0001) in the seropositive control and 1.9% (p <0.0001) in the seronegative control. Adjusting for age and gender, the seronegative control was less likely to develop ACS than the study group within one year (OR = 0.4, 95% CI 0.2-0.7, p = 0.003).

Conclusions: This retrospective study demonstrates that CMV infection may be a significant risk factor for VTE and ACS.

Keywords: acquired coagulation disorders; acute coronary syndromes; arterial thrombosis; cmv; cytomegalovirus; thrombo embolic disease; venous thromboembolism; venous thrombosis; viral host interactions; viral infection.