Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy
Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy
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DOI：
10.1001/archinte.160.22.3431
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发表时间：
2000-12-11
影响因子：
--
通讯作者：
Ginsberg, JS
中科院分区：
文献类型：
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作者：
Douketis, JD;Foster, GA;Ginsberg, JS
背景：对于静脉血栓栓塞 (VTE) 患者，识别抗凝治疗最初 3 个月内复发的临床危险因素以及了解复发的时间过程可能有助于临床医生决定临床监测的频率和门诊治疗的适当性。 方法：对包含 1021 名 VTE 患者（其中 750 名患有深静脉血栓）的随机对照试验数据库进行分析 [DVT] 和 271 名患有肺栓塞 [PE] 的患者在开始抗凝治疗后进行了 3 个月的随访。所有患者从治疗第一天或第二天开始接受普通肝素或低分子量肝素（瑞维肝素）和香豆素衍生物的初始治疗，目标国际标准化比率为 2.0 至 3.0。 结果：确定了复发性 VTE 的四个独立临床危险因素：(1) 癌症（比值比 [OR]，2.72；95% 置信区间 [CI]， 1.39-5.32），（2）慢性心血管疾病（OR，2.27；95% CI，1.08-4.97），（3）慢性呼吸道疾病（OR，1.91；95% CI，0.85-4.26），（4）其他有临床意义的疾病（OR，1.79；95% CI，1.00-3.21）。年龄较大与 VTE 复发风险降低相关（OR，0.76；95% CI，0.64-0.92）。既往 VTE、性别和特发性 VTE 不是复发的危险因素。在 DVT 或 PE 患者中，复发性非致命性 VTE 的发生率（4.8% vs 4.1%；P = .62）、大出血（2.9% vs 2.2%；P = .53）和非 VTE 死亡（6.4% vs 7.8%；P = .45）的发生率没有显着差异，但 PE 患者中复发性致命性 PE 的发生率高于 DVT（2.2% vs 0%；P = .45）。磷
Background: In patients with venous thromboembolism (VTE), identifying clinical risk factors for recurrence during the initial 3 months of anticoagulant therapy and knowledge of the time course of recurrence may help clinicians decide about the frequency of clinical surveillance and the appropriateness of outpatient treatment.Methods: Analysis of a randomized controlled trial database involving 1021 patients with VTE (750 with deep vein thrombosis [DVT] and 271 with pulmonary embolism [PE]) who were followed up for 3 months after the start of anticoagulant therapy. All patients received initial treatment with unfractionated heparin or a low-molecular-weight heparin (reviparin) and a coumarin derivative starting the first or second day of treatment, with a target international normalized ratio of 2.0 to 3.0.Results: Four independent clinical risk factors for recurrent VTE were identified: (1) cancer (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.39-5.32), (2) chronic cardiovascular disease (OR, 2.27; 95% CI, 1.08-4.97), (3) chronic respiratory disease (OR, 1.91; 95% CI, 0.85-4.26), and (4) other clinically significant medical disease (OR, 1.79; 95% CI, 1.00-3.21). Older age was associated with a decreased risk for recurrent VTE (OR, 0.76; 95% CI, 0.64-0.92). Previous VTE, sex, and idiopathic VTE were not risk factors for recurrence. In patients with DVT or PE, there was no significant difference in the rates of recurrent nonfatal VTE (4.8% vs 4.1%; P = .62), major bleeding (2.9% vs 2.2%; P = .53), and non-VTE death (6.4% vs 7.8%; P = .45), but recurrent fatal PE was more frequent in patients with PE than DVT (2.2% vs 0%; P