Mild Antithrombin Deficiency and Risk of Recurrent Venous Thromboembolism A Prospective Cohort Study
Mild Antithrombin Deficiency and Risk of Recurrent Venous Thromboembolism A Prospective Cohort Study
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DOI：
10.1161/circulationaha.113.003756
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发表时间：
2014-01-28
期刊：
影响因子：
37.8
通讯作者：
Ageno, Walter
中科院分区：
文献类型：
--
作者：
Di Minno, Matteo Nicola Dario;Dentali, Francesco;Ageno, Walter
背景：抗凝血酶缺乏，即抗凝血酶水平<70%，是一种与静脉血栓栓塞（VTE）风险增加相关的主要血栓性疾病。没有关于静脉血栓栓塞复发风险与抗凝血酶水平轻度降低（70-80%）相关的前瞻性数据。方法与结果根据抗凝血酶功能水平（<70%,70-80%,> - 80%）对连续的首次静脉血栓栓塞患者进行分层，平均随访8.70年，以评估静脉血栓栓塞复发的发生率。共纳入823例患者（平均年龄48.3岁，男性41.9%）。静脉血栓栓塞复发253例（3.53% /患者年）。对抗凝血酶水平进行分层，抗凝血酶水平<70%的患者有19例（5.90% /患者-年），抗凝血酶水平在70% - 80%的患者有20例（5.35% /患者-年），抗凝血酶水平在80%以上的患者有214例（3.31% /患者-年）发生静脉血栓栓塞复发。调整主要血栓栓塞危险因素和抗凝时间后，抗凝酶水平<70%（风险比3.48,95%可信区间2.16-5.61）和抗凝酶水平70% - 80%（风险比2.40,95%可信区间1.51-3.80）的患者血栓栓塞复发风险明显高于抗凝酶水平为80%的患者。当根据指数事件主要危险因素的存在与否对人群进行分层时，这种关联仅在非诱发性静脉血栓栓塞患者中保持显著。结论：非诱发性静脉血栓栓塞患者存在轻度抗凝血酶缺乏（70-80%）与复发风险显著增加相关，在确定二级预防持续时间时应考虑到这一点。临床试验注册网址：http://www.clinicaltrials.gov。唯一标识符：NCT01382550。
BackgroundAntithrombin deficiency, defined by antithrombin levels of <70%, is a major thrombophilic condition associated with an increased risk of venous thromboembolism (VTE). No prospective data are available about the risk of recurrent VTE associated with mildly decreased antithrombin levels (70–80%).Methods and ResultsConsecutive patients with a first VTE were stratified according to functional antithrombin levels (<70%, 70–80%, >80%) and were followed up for a mean of 8.70 years to assess the incidence of VTE recurrence. A total of 823 patients (mean age, 48.3 years; 41.9% male) were enrolled. Recurrent VTE occurred in 253 patients (3.53% per patient-year). With stratification for antithrombin levels, VTE recurrence occurred in 19 patients with antithrombin levels <70% (5.90% per patient-year), in 20 patients with antithrombin levels 70% to 80% (5.35% per patient-year), and in 214 patients with antithrombin levels >80% (3.31% per patient-year). After adjustment for major VTE risk factors and for anticoagulation duration, the risk of VTE recurrence was significantly higher in patients with antithrombin levels <70% (hazard ratio, 3.48; 95% confidence interval, 2.16–5.61) and antithrombin levels 70% to 80% (hazard ratio, 2.40; 95% confidence interval, 1.51–3.80) compared with patients with antithrombin levels >80%. When the population was stratified according to the presence or absence of major risk factors for the index event, the association remained significant only in patients with unprovoked VTE.ConclusionsThe presence of mild antithrombin deficiency (70–80% antithrombin) in patients with unprovoked VTE is associated with a significantly increased risk of recurrence and should be taken into account when the duration of secondary prevention is determined.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01382550.