In Children with Provoked Venous Thromboembolism, Increasing Plasma Coagulability during the First 3 Months Postdiagnosis is Prognostic of Recurrence.
In Children with Provoked Venous Thromboembolism, Increasing Plasma Coagulability during the First 3 Months Postdiagnosis is Prognostic of Recurrence.
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DOI：
10.1055/s-0040-1708879
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发表时间：
2020-05
影响因子：
6.7
通讯作者：
Goldenberg NA
中科院分区：
文献类型：
--
作者：
Betensky M;Mueller MG;Amankwah EK;Goldenberg NA
诱发 VTE 后静脉血栓栓塞 (VTE) 复发的预后因素在很大程度上尚不清楚。使用凝块形成和溶解 (CloFAL) 测定法，单一机构研究表明，在儿科 VTE 后的前 3 个月内，急性高凝状态总体改善，但部分患者的血浆凝血能力有所上升。我们试图确定 VTE 诱发后前 3 个月内凝血能力升高的发生率，研究其与 D-二聚体升高的关系，并检验凝血能力显着升高是 VTE 复发的独立预后这一假设。在约翰·霍普金斯大学儿科 VTE 队列和美国国立卫生研究院资助的 Kids-DOTT 试验中，在 VTE 后 4 至 6 周和 3 个月时对血浆进行了 CloFAL 和 D-二聚体测定。通过逻辑回归评估 VTE 复发与 D-二聚体和 CloFAL 测定测量值的关联。其中包括八十七名患者。中位随访时间为 1 年。 6 周时确定完全静脉闭塞率为 12%。在 VTE 后的前 3 个月内，通过 CloFAL 检测观察到 17% 的患者凝血能力显着升高，而 21% 的患者 D-二聚体升高。 10% 的患者出现复发性 VTE。 CloFAL 检测（而非 D-二聚体）与复发相关（比值比 [OR] 5.87，95% 置信区间 [95% CI]，1.34–25.8]）。调整静脉闭塞后，CloFAL 检测发现凝血能力显着升高的患者复发 VTE 的风险增加 10 倍（OR 10.33 [95% CI，1.83–58.19]）。未来的工作应寻求阐明诱发 VTE 后血浆凝固性升高的机制，并证实其对复发性 VTE 的预后效用。
Prognostic factors for venous thromboembolism (VTE) recurrence following provoked VTE are largely unknown. Using the Clot Formation and Lysis (CloFAL) assay, single institutional research has shown overall improvement in acute hypercoagulability during the first 3 months postpediatric VTE, yet a rise in plasma coagulability in a subgroup of patients. We sought to define the incidence of rise in coagulability during the first 3 months post-provoked VTE, to investigate its relationship with elevated D-dimer, and to test the hypothesis that a marked rise in coagulability is independently prognostic of VTE recurrence. CloFAL and D-dimer assays were performed on plasma at 4 to 6 weeks and 3 months post-VTE in the Johns Hopkins pediatric VTE cohort and National Institutes of Health-sponsored Kids-DOTT trial. Associations of VTE recurrence with D-dimer and CloFAL assay measures were evaluated via logistic regression. Eighty-seven patients were included. Median follow-up was 1 year. Complete veno-occlusion was determined in 12% at 6 weeks. During the first 3 months post-VTE, a marked rise in coagulability was observed by CloFAL assay in 17% of patients, while D-dimer was elevated in 21%. Recurrent VTE occurred in 10% of patients. CloFAL assay, but not D-dimer, was associated with recurrence (odds ratio [OR] 5.87, 95% confidence interval [95% CI], 1.34–25.8]). After adjustment for veno-occlusion, patients with a marked rise in coagulability by CloFAL assay had a 10-fold increased risk of recurrent VTE (OR 10.33 [95% CI, 1.83–58.19]). Future work should seek to elucidate the mechanisms underlying a rise in plasma coagulability following provoked VTE and to substantiate its prognostic utility for recurrent VTE.
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