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Canadian Journal of Cardiology

Venous Thromboembolism Caused by Spending a Night in a Vehicle After an Earthquake (Night in a Vehicle After the 2016 Kumamoto Earthquake)

      In recent years, the relationship between an earthquake disaster and the occurrence of venous thromboembolism (VTE) has been clarified,
      • Aoki T.
      • Fukumoto Y.
      • Yasuda S.
      • et al.
      The great East Japan earthquake disaster and cardiovascular diseases.
      and it has become a social problem. Although the risk of spending the night in a vehicle during disaster has been addressed by the mass media, the relationship between spending a night in a vehicle and VTE remains to be elucidated.
      In April 2016, the Kumamoto earthquakes
      • Sueta D.
      • Akahoshi R.
      • Okamura Y.
      • et al.
      Venous thromboembolism due to oral contraceptive intake and spending nights in a vehicle-a case from the 2016 Kumamoto earthquakes.
      occurred. Regarding the characteristics of the earthquake, the number of aftershocks at night was very high. Therefore, many victims were afraid to return to their homes and chose to evacuate. At that time, although some people evacuated to a public evacuation shelter provided by the administration, many victims were forced to stay in their vehicles (Supplemental Fig. S1). Questionnaires from 21 local medical institutions revealed that 51 VTE patients were determined to require hospitalization after the earthquake until the end of May 2016. Supplemental Figure S2 indicates the daily number of patients who required hospitalization due to VTE associated with this earthquake. Of the 51 enrolled patients, 42 (82.4%) spent a night in a vehicle.
      Table 1 shows a comparison of the demographic and clinical parameters between patients in the non-night-in-vehicle group (n = 9) and the night-in-vehicle group (n = 42). The age and onset days after the earthquake were significantly higher in the night-in-vehicle group, and the presence of pulmonary thromboembolism (PTE) was significantly higher in the non-night-in-vehicle group. The D-dimer concentration levels tended to be lower in the night-in-vehicle group than in the non-night-in-vehicle group. Supplemental Table S1 shows a comparison of the treatment between patients in the non-night-in-vehicle group and the night-in-vehicle group. The use of inferior vena cava filters was significantly higher in the non-night-in-vehicle group. Then, patients were divided into 2 different groups: the PTE absent group (n = 13) and the PTE present group (n = 38; Supplemental Table S2). The age and onset days after the earthquake were significantly higher in the PTE absent group, and the experience of spending a night in a vehicle was significantly more prevalent in the PTE present group.
      Table 1Comparison of demographic and clinical parameters between patients with or without the night in a vehicle
      Total (n = 51)Night in a vehicle (−) (n = 9)Night in a vehicle (+) (n = 42)P
      Age, years67.3 ± 14.279.8 ± 12.164.6 ± 13.30.001
      Men, %13 (25)2 (22)11 (26)0.81
      Onset after earthquake, days9.5 ± 12.020.1 ± 25.67.3 ± 5.30.003
      Pulmonary thromboembolism, %38 (75)3 (33)35 (83)0.001
      Heart failure history, %3 (5.9)2 (11)1 (2)0.24
      Lung disease history, %1 (2)0 (0)1 (2)0.64
      Malignancy history, %7 (13.7)2 (22)5 (12)0.44
      Pulse rate > 100 bpm2 (3.9)0 (0)2 (5)0.51
      Systolic BP < 100 mm Hg7 (13.7)1 (11)6 (14)0.81
      Respiratory rate > 30/min4/49 (8.2)0 (0)4/40 (10)0.36
      Body temperature < 36.0°C7/49 (14.3)1 (11)6/40 (15)0.77
      D-dimer levels, μg/mL14.1 ± 13.121.8 ± 23.712.5 ± 9.30.07
      BP, blood pressure; bpm, beats per minute.
      We first described the clinical significance of spending a night in a vehicle during a disaster. Preventive awareness activities conducted by professional medical teams in conjunction with using mass media to widely broadcast the risk of VTE as a result of spending a night in a vehicle, and living in an evacuation centre leads to a reduction in the number of VTE victims.

      Acknowledgements

      This report is dedicated to all victims of the 2016 Kumamoto Earthquake.
      We thank all KEEP project members and study investigators for their devoted investigations in the retrospective clinical record observations. We also thank all paramedic staff and clinical secretaries for their kind support during this work. Kumamoto Nichinichi Shimbun kindly supplied a photograph and gave us the license for its use in this publication.

      Funding Sources

      Grants from the Japan Cardiovascular Research Foundation and Japan Agency for Medical Research and Development. Registration: University Hospital Medical Information Network (UMIN)-CTR (http://www.umin.ac.jp/ctr/). Identifier: UMIN000023864. Opt-out materials are available at: http://www.kumadai-junnai.com/home/wp-content/uploads/shinsai.pdf.

      Disclosures

      Yoichiro Hashimoto has received honoraria from Pfizer Japan Inc, Daiichi Sankyo Co Ltd, Bayer Yakuhin Co Ltd, Bristol-Myers Squibb Co Ltd, Otsuka Seiyaku Co Ltd, and Eisai Co Ltd. Kenji Sakamoto has received significant research grant support from Daiichi Sankyo Co, Ltd. Kazuhiro Nishigami has received honoraria as a lecture fee from Amgen Astellas BioPharma KK, Bayer Yakuhin, Ltd, Daiichi Sankyo Co, Ltd, MSD KK, Sanofi KK, AstraZeneca KK, Boehringer Ingelheim Japan, Chugai Pharmaceutical Co, Ltd, Eisai Co, Ltd, Kowa Pharmaceutical Co Ltd, Mitsubishi Tanabe Pharma, Pfizer Japan Inc, Sanofi KK, Shionogi & Co, Ltd, and Takeda Pharmaceutical Co, Ltd. Sunao Kojima has received significant research grant support from Teijin Home Healthcare Limited and Philips Respironics Goudou Kaisha. Kenichi Tsujita has received honoraria from Amgen Astellas BioPharma KK, Bayer Yakuhin, Ltd, Daiichi Sankyo Co, Ltd, MSD KK, and Sanofi KK, and has received grants from AstraZeneca KK, Astellas Pharma Inc, Bayer Yakuhin, Ltd, Boehringer Ingelheim Japan, Boston Scientific Japan KK, Chugai Pharmaceutical Co, Ltd, Daiichi Sankyo Co, Ltd, Eisai Co, Ltd, Kowa Pharmaceutical Co Ltd, Mitsubishi Tanabe Pharma, MSD KK, Pfizer Japan Inc, Sanofi KK, Shionogi & Co, Ltd, and Takeda Pharmaceutical Co, Ltd. The remaining authors have no conflicts of interest to disclose.

      Supplementary Material

      References

        • Aoki T.
        • Fukumoto Y.
        • Yasuda S.
        • et al.
        The great East Japan earthquake disaster and cardiovascular diseases.
        Eur Heart J. 2012; 33: 2796-2803
        • Sueta D.
        • Akahoshi R.
        • Okamura Y.
        • et al.
        Venous thromboembolism due to oral contraceptive intake and spending nights in a vehicle-a case from the 2016 Kumamoto earthquakes.
        Intern Med. 2017; 56: 409-412

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      • Erratum
        Canadian Journal of CardiologyVol. 34Issue 10
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          In the article, “Venous Thromboembolism Caused by Spending a Night in a Vehicle After an Earthquake (Night in a Vehicle After the 2016 Kumamoto Earthquake)” (Can J Cardiol 2018;34: 813.e9-10), by Sueta et al., there is error in the second sentence of the third paragraph. The corrected sentence appears here with the corrected text in bold. “The age and onset days after the earthquake were significantly higher in the non-night-in-vehicle group, and the presence of pulmonary thromboembolism (PTE) was significantly higher in the night-in-vehicle group.”
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