The long-term clinical course of acute deep venous thrombosis
The long-term clinical course of acute deep venous thrombosis
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DOI：
10.7326/0003-4819-125-1-199607010-00001
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发表时间：
1996-07-01
影响因子：
39.2
通讯作者：
Prins, MH
中科院分区：
文献类型：
--
作者：
Prandoni, P;Lensing, AWA;Prins, MH
工作背景：在有症状的深静脉血栓形成患者中，复发性静脉血栓栓塞的长期风险以及血栓形成后后遗症的发生率和严重程度尚未得到很好的记录。目的：确定患者首次发生有症状的深静脉血栓形成后8年内的临床病程。设计：前瞻性队列研究。设置：大学门诊血栓形成诊所。患者：连续355例首次出现症状性深静脉血栓形成的患者，测量指标：复发性静脉血栓栓塞、血栓后综合征和死亡。结果：随访2年后，静脉血栓栓塞复发的累积发生率为17.5%（95%CI，13.6%至22.2%），5年后为24.6%（CI，19.6%至29.7%），8年后为30.3%（CI，23.6%至37.0%）。癌症和凝血抑制受损的存在增加了复发性静脉血栓栓塞的风险（风险比分别为1.72 [CI，1.31至2.25]和1.44 [CI，1.02至2.01]）。相反，手术和近期创伤或骨折与复发性静脉血栓栓塞风险降低相关（风险比分别为0.36 [CI，0.21 - 0.62]和0.51 [CI，0.32 - 0.87]）。血栓形成后综合征的累积发生率在2年后为22.8%（CI，18.0%至27.5%），5年后为28.0%（CI，22.7%至33.3%），8年后为29.1%（CI，23.4%至34.7%）。同侧复发性深静脉血栓形成的发生与血栓后综合征的风险密切相关（风险比，6.4; CI，3.1至13.3）。8年后的生存率为70.2%（CI，64.7%至75.6%）。癌症的存在增加了死亡的风险（风险比，8.1; CI，3.6至18.1）。结论：有症状的深静脉血栓形成的患者，特别是那些没有短暂的深静脉血栓形成的危险因素，有很高的风险，持续多年的复发性静脉血栓栓塞。血栓形成后综合征发生在几乎三分之一的这些患者，是密切相关的同侧复发性深静脉血栓形成。这些发现挑战了在有症状的深静脉血栓形成患者中广泛采用的短程抗凝治疗。
Background: In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well documented.Objective: To determine the clinical course of patients during the 8 years after their first episode of symptomatic deep venous thrombosis.Design: Prospective cohort study.Setting: University outpatient thrombosis clinic.Patients: 355 consecutive patients with a first episode of symptomatic deep venous thrombosis.Measurements: Recurrent venous thromboembolism, the post-thrombotic syndrome, and death. Potential risk factors for these outcomes were also evaluated.Results: The cumulative incidence of recurrent venous thromboembolism was 17.5% after 2 years of follow-up (95% CI, 13.6% to 22.2%), 24.6% after 5 years (CI, 19.6% to 29.7%), and 30.3% after 8 years (CI, 23.6% to 37.0%). The presence of cancer and of impaired coagulation inhibition increased the risk for recurrent venous thromboembolism (hazard ratios, 1.72 [CI, 1.31 to 2.25] and 1.44 [CI, 1.02 to 2.01], respectively). In contrast, surgery and recent trauma or fracture were associated with a decreased risk for recurrent venous thromboembolism (hazard ratios, 0.36 [CI, 0.21 to 0.62] and 0.51 [CI, 0.32 to 0.87], respectively). The cumulative incidence of the post-thrombotic syndrome was 22.8% after 2 years (CI, 18.0% to 27.5%), 28.0% after 5 years (CI, 22.7% to 33.3%), and 29.1% after 8 years (CI, 23.4% to 34.7%). The development of ipsilateral recurrent deep venous thrombosis was strongly associated with the risk for the post-thrombotic syndrome (hazard ratio, 6.4; CI, 3.1 to 13.3). Survival after 8 years was 70.2% (CI, 64.7% to 75.6%). The presence of cancer increased the risk for death (hazard ratio, 8.1; CI, 3.6 to 18.1).Conclusion: Patients with symptomatic deep venous thrombosis, especially those without transient risk factors for deep venous thrombosis, have a high risk for recurrent venous thromboembolism that persists for many years. The post-thrombotic syndrome occurs in almost one third of these patients and is strongly related to ipsilateral recurrent deep venous thrombosis. These findings challenge the widely adopted use of short-course anticoagulation therapy in patients with symptomatic deep venous thrombosis.