Impact of high risk thrombophilia status on recurrence among children and adults with VTE: An observational multicenter cohort study
Impact of high risk thrombophilia status on recurrence among children and adults with VTE: An observational multicenter cohort study
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DOI：
10.1016/j.bcmd.2016.10.024
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发表时间：
2016-11-01
影响因子：
2.3
通讯作者：
Nowak-Goettl, Ulrike
中科院分区：
文献类型：
--
作者：
Bruewer, Gloria;Limperger, Verena;Nowak-Goettl, Ulrike
背景：抗凝血酶 [AT]-、蛋白 C [PC]- 或蛋白 S [PS]- 缺乏 [D] 是静脉血栓栓塞 [VIE] 的主要危险因素。主要研究目的是评估儿童和成人首次 VTE 发作时的临床表现是否不同，并比较患者在发病年龄及其血栓形成倾向 ATD、PCD 或 PSD 状态方面的个体复发风险。 方法/患者/结果：在 688 名连续入组的儿童和成人 VTE 患者中，我们计算了 137 名 VTE 复发的绝对风险和根据血栓形成倾向和阳性家族 VTE 病史进行调整后的无事件生存率。与青少年和成人相比，VTE 儿童首先表现出 i) 肺栓塞发生率较低，ii) 脑血管事件或多种 VIES 发生率较高，并且无端 VIE 的比例较高。与年轻的研究参与者相比，成年患者更常报告阳性 VIE 病史。与儿童相比，成人的调整后复发几率为 2.05。 结论：在疾病表现方面，儿童和成人在以下方面存在差异：i) 血栓位置，ii) 无诱发性 VIE 与诱发性 VIE 的百分比，以及 iii) 阳性 VTE 家族史的不同比率。此外，与儿童相比，成人 VTE 复发的风险增加两倍。 (C) 2016 Elsevier Inc. 保留所有权利。
Background: Antithrombin [AT]-, protein C [PC]- or protein S [PS]-deficiency [D] constitutes a major risk factor for venous thromboembolism [VIE]. Primary study objective was to evaluate if the clinical presentation at first VTE onset differs between children and adults and to compare the individual recurrence risk among patients with respect to age at onset and their thrombophilia status ATD, PCD or PSD.Methods/Patients/Results: In 137 of 688 consecutively enrolled pediatric and adult VTE patients we calculated the absolute risk of VTE recurrence and event-free-survival adjusted for thrombophilia and positive family VTE history. At first VTE children manifested i) with a lower rate of pulmonary embolism, ii) a higher rate of cerebral vascular events or multiple VIES, and showed a higher proportion of unprovoked VIE compared to adolescents and adults. Adult patients reported more often a positive VIE history compared to younger study participants. The adjusted odds of recurrence in adults was 2.05 compared to children.Conclusion: At disease manifestation children and adults differ with respect to i) thrombotic locations, ii) percentage of unprovoked versus provoked VIE, and iii) different rates of positive VTE family histories. Furthermore, adults showed a two-fold increase risk of VTE recurrence compared to children. (C) 2016 Elsevier Inc. All rights reserved.