Prediction of Recurrent Venous Thromboembolism by Clot Lysis Time: A Prospective Cohort Study
Prediction of Recurrent Venous Thromboembolism by Clot Lysis Time: A Prospective Cohort Study
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DOI：
10.1371/journal.pone.0051447
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发表时间：
2012-12-11
期刊：
影响因子：
3.7
通讯作者：
Kyrle, Paul A.
中科院分区：
文献类型：
--
作者：
Traby, Ludwig;Kollars, Marietta;Kyrle, Paul A.
静脉血栓栓塞症（VTE）是一种易复发的慢性疾病。纤溶系统异常是否与静脉血栓栓塞风险增加有关尚不清楚。我们评估了纤维蛋白溶解能力（通过血块溶解时间[CLT]反映）与VTE复发风险之间的关系。我们随访了704例（378例女性，平均年龄48岁）首次发生无端静脉血栓栓塞的患者，在抗凝停药后平均随访46个月。天然凝血抑制物缺乏、狼疮抗凝、癌症、凝血因子V Leiden纯合性或凝血酶原突变或需要无限期抗凝的患者被排除。研究终点为症状性复发性VTE。为了测量CLT，通过加入组织型纤溶酶原激活剂来溶解组织因子诱导的凝块。通过测量浊度确定凝块形成和溶解之间的时间。135例（19%）患者复发性VTE。CLT每增加10分钟，复发的粗相对风险（RR）为1.13（95%CI 1.02-1.25; p = 0.02），调整年龄和性别后为1.08（95%CI 0.98-1.20; p = 0.13）。仅对于女性，CLT每增加10分钟，调整后的RR为1.14（95% CI，0.91-1.42，p = 0.22）。与第一四分位数中的值相比，女性患者人群第四分位数中的CLT值提供了3.28的复发风险（95% CI，1.07-10.05; p = 0.04）。在男性中未发现CLT与复发风险之间的相关性。通过CLT评估的纤溶功能减退可中度增加VTE复发的风险。仅在女性中发现CLT与复发风险之间的弱相关性。
Venous thromboembolism (VTE) is a chronic disease, which tends to recur. Whether an abnormal fibrinolytic system is associated with an increased risk of VTE is unclear. We assessed the relationship between fibrinolytic capacity (reflected by clot lysis time [CLT]) and risk of recurrent VTE. We followed 704 patients (378 women; mean age 48 yrs) with a first unprovoked VTE for an average of 46 months after anticoagulation withdrawal. Patients with natural coagulation inhibitor deficiency, lupus anticoagulant, cancer, homozygosity for factor V Leiden or prothrombin mutation, or requirement for indefinite anticoagulation were excluded. Study endpoint was symptomatic recurrent VTE. For measurement of CLT, a tissue factor-induced clot was lysed by adding tissue-type plasminogen activator. Time between clot formation and lysis was determined by measuring the turbidity. 135 (19%) patients had recurrent VTE. For each increase in CLT of 10 minutes, the crude relative risk (RR) of recurrence was 1.13 (95% CI 1.02-1.25; p = 0.02) and was 1.08 (95% CI 0.98-1.20; p = 0.13) after adjustment for age and sex. For women only, the adjusted RR was 1.14 (95% CI, 0.91-1.42, p = 0.22) for each increase in CLT of 10 minutes. CLT values in the 4th quartile of the female patient population, as compared to values in the 1st quartile, conferred a risk of recurrence of 3.28 (95% CI, 1.07-10.05; p = 0.04). No association between CLT and recurrence risk was found in men. Hypofibrinolysis as assessed by CLT confers a moderate increase in the risk of recurrent VTE. A weak association between CLT and risk of recurrence was found in women only.