Role of Vitamin D Levels in Venous Thrombosis

Venous thromboembolism (VTE) is a complex condition that impacts over 900,000 people in the

United States annually. It is estimated that about 100,000 people in the US die from deep vein

thrombosis (DVT) or pulmonary embolism (PE) annually. Several biomarkers, including

Vitamin D most recently, have been investigated and linked to the risk of developing VTE or

recurrent VTE. Vitamin D is known to control the expression of over 200 genes and it has shown

to have anti-thrombotic effects through various mechanisms. There is emerging data regarding

its role in the coagulation pathway, platelet activation, inflammatory pathways and endothelial

activation (1). There have been a few international studies linking Vitamin D deficiency to

VTE(2). However; no such study has been replicated in the North American population where the prevalence of Vitamin D deficiency is 40%. The focus of this study will be to determine the

prevalence of Vitamin D deficiency in patients with VTE. Based on the role of Vitamin D in the

pathway for thrombogenesis and antithrombin effects, there is likely a correlation between VTE

and Vitamin D levels.

This is a retrospective chart review of all patients admitted to Franciscan Health- Olympia Fields

with VTE between July 2018 and June2020. A total of 181 patients with VTE were reviewed.

Data such as age, gender, race, D-dimer, and Vitamin D levels were collected. Vitamin D levels

<30ng/mL was defined as deficient. In addition, further data collection, included provoked vs

unprovoked VTE, presence of malignancy, and the severity of DVT and PE based on location

and extent of the VTE (severity was scored on a scale of 1-3 with 1 being mild and 3 as severe).

A regression analysis was done to find a correlation between several variables and T-test was

used to determine P-value.

Of the 181 patients, 110 had a vitamin D level documented at the time of their VTE and data

was specifically analyzed for this subgroup. There were 46 males and 64 females, 53.6%AA,

7.3% Hispanic, 38.2% Caucasian, and 0.9% unknown. 25.5% had an unprovoked VTE event

and 74.5% had a provoked event. 39 patients had a known active malignancy and a likely

cancer associated thrombosis. 85.7% of patients with unprovoked DVT had a low Vitamin D

level. In patients with cancer associated thrombosis there was no significant correlation with

vitamin D levels. A strong correlation was noted between vitamin D levels and the severity of PE

(p value=0.036).

This retrospective chart review from a patient population at a community hospital indicates that

there is some correlation between venous thromboembolism and Vitamin D levels. Specifically,

it appears that patients with an unprovoked VTE have low Vitamin D levels suggesting that

vitamin D deficiency may be a risk factor for VTE development as indicated by previous

international studies (2). In addition, it appears that there is an inverse relationship between the

severity of PE and vitamin D levels. Perhaps Vitamin D may be used as a biomarker for VTE

risk assessment and management. Large scale studies are needed in the future to determine

the exact relationship between VTE and Vitamin D and further studies are needed to test the

role of vitamin D supplementation and risk of recurrent VTE.