Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study.
Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study.
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DOI：
10.1186/s12885-017-3326-1
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发表时间：
2017-05-19
期刊：
影响因子：
3.8
通讯作者：
Tsuji Y
中科院分区：
文献类型：
--
作者：
Kitayama H;Kondo T;Sugiyama J;Kurimoto K;Nishino Y;Hirayama M;Tsuji Y
尽管亚洲人群被认为具有较低的静脉血栓栓塞（VTE）风险，但其在恶性肿瘤患者中的患病率和发病率仍不清楚。我们试图用凝血和纤溶的激活标记物来预测静脉血栓栓塞的发展。我们招募了2014年4月至12月在Tonan医院住院的恶性肿瘤患者，接受了一种新的化疗方案。所有患者在化疗前和化疗后3个月分别通过计算机断层扫描和全腿压缩超声检查静脉血栓栓塞。我们还检查了化疗前血浆凝血酶-抗凝血酶复合物（TAT）和纤溶酶α - 2-纤溶酶抑制剂复合物（PIC）的水平。TAT和PIC的临界值分别为2.1 ng/mL和1.8 ng/mL。在97例患者中，大多数（67%）有远处转移。最常见的恶性肿瘤是结直肠癌（26%）、乳腺癌（23%）和胃癌（19%）。静脉血栓栓塞29例（31%）；所有患者均无症状。在三个月的观察期内，有12例患者新发静脉血栓栓塞，即发病率为每1000人年49例。多因素分析显示，PIC未增高与TAT增高是影响VTE患病率和发病率的唯一显著危险因素，比值比分别为3.0（95%可信区间1.1 ~ 8.2,P = 0.034）和9.4（95%可信区间1.7 ~ 51.9,P = 0.011）。日本住院恶性肿瘤化疗患者静脉血栓栓塞的患病率和发病率较高。未增加的PIC与增加的TAT水平可能是静脉血栓形成的独立危险因素。
Although Asian population was recognized to have a lower risk of venous thromboembolism (VTE), its increasing prevalence and incidence remain unclear in patients with malignancies. We attempted to predict VTE development using activation markers of coagulation and fibrinolysis. We enrolled patients with malignancy admitted to Tonan Hospital between April and December 2014 to receive a new-for-them chemotherapy regimen. All patients were examined for VTE by computed tomography and whole-leg compression ultrasonography before chemotherapy and three months later. We also examined plasma levels of thrombin-antithrombin complex (TAT) and plasmin α2-plasmin inhibitor complex (PIC) before chemotherapy. The cut off values of TAT and PIC were set at 2.1 ng/mL and 1.8 μg/mL, respectively. Of 97 patients, the majority (67%) had distant metastases. The most common malignancies were colorectal (26%), breast (23%), and stomach (19%) cancer. VTE was detected in 29 patients (31%); all were asymptomatic. VTE was newly developed in 12 patients in the three-month observation period, which means the incidence was 49 per 1000 person-years. Non-increased PIC with increased TAT was the only significant risk factor for both VTE prevalence and incidence in multivariate analysis, and the odds ratios were 3.0 (95% confidence interval, 1.1–8.2; P = 0.034) and 9.4 (95% confidence interval, 1.7–51.9; P = 0.011), respectively. The prevalence and incidence of VTE were high in hospitalized Japanese patients receiving chemotherapy for malignancies. Non-increased PIC with increased levels of TAT may be an independent risk factor for VTE development.