Predictors of recurrence after deep vein thrombosis and pulmonary embolism -: A population-based cohort study
Predictors of recurrence after deep vein thrombosis and pulmonary embolism -: A population-based cohort study
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DOI：
10.1001/archinte.160.6.761
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发表时间：
2000-03-27
影响因子：
--
通讯作者：
Melton, LJ
中科院分区：
文献类型：
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作者：
Heit, JA;Mohr, DN;Melton, LJ
背景资料：静脉血栓栓塞症（VTE）首次发作后口服抗凝剂的适当持续时间是不确定的，取决于VTE复发率。目的：估计VTE复发率并确定复发的预测因素。明尼苏达州奥姆斯特德县的患者，在1966年至1990年的25年期间首次诊断出深静脉血栓形成或肺栓塞（N = 1719）通过社区首次VTE复发的完整病历及时进行随访。结果：在10198人-年的随访中，404例患者发生了复发性VTE。7、30和180天以及1和10年时VTE复发的总体（很可能/明确）累积百分比分别为1.6%（0.2%）、5.2%（1.4%）、10.1%（4.1%）、12.9%（5.6%）和30.4%（17.6%）。复发的风险在最初事件发生后的前6至12个月内最大，但从未降至零。1966年至1980年期间，首次总体VTE复发的独立预测因素包括年龄和体重指数的增加、神经系统疾病伴轻瘫、恶性肿瘤和神经外科手术。首次很可能/明确复发的独立预测因素包括医院获得性VTE患者中事件和神经系统疾病的诊断确定性。复发风险增加恶性肿瘤，但不同的伴随化疗，患者的年龄和性别，和studyear.Conclusions：静脉血栓栓塞复发频繁，特别是在第一个6至12个月，并继续复发至少10年后，最初的静脉血栓栓塞。伴有神经系统疾病和轻瘫或恶性肿瘤的VTE患者复发风险增加，而伴有一过性或可逆性风险因素的VTE患者复发风险较低。
Background: The appropriate duration of oral anticoagulation after a first episode of venous thromboembolism (VTE) is uncertain and depends upon VTE recurrence rates.Objective: To estimate VTE recurrence rates and determine predictors of recurrence.Methods: Patients in Olmsted County, Minnesota, with a first lifetime deep vein thrombosis or pulmonary embolism diagnosed during the 25-year period from 1966 through 1990 (N = 1719) were followed forward in time through their complete medical records in the community for first VTE recurrence.Results: Four hundred four patients developed recurrent VTE during 10 198 person-years of follow-up. The overall (probable/definite) cumulative percentages of VTE recurrence at 7, 30, and 180 days and 1 and 10 years were 1.6% (0.2%), 5.2% (1.4%), 10.1% (4.1%), 12.9% (5.6%), and 30.4% (17.6%), respectively. The risk of recurrence was greatest in the first 6 to 12 months after the initial event but never fell to zero. Independent predictors of first overall VTE recurrence included increasing age and body mass index, neurologic disease with paresis, malignant neoplasm, and neurosurgery during the period from 1966 through 1980. Independent predictors of first probable/definite recurrence included diagnostic certainty of the incident event and neurologic disease in patients with hospital-acquired VTE. Recurrence risk was increased by malignant neoplasm but varied with concomitant chemotherapy, patient age and sex, and study year.Conclusions: Venous thromboembolism recurs frequently, especially within the first 6 to 12 months, and continues to recur for at least 10 years after the initial VTE. Patients with VTE with neurologic disease and paresis or with malignant neoplasm are at increased risk for recurrence, while VTE patients with transient or reversible risk factors are at less risk.