Thromboembolism in hospitalized neutropenic cancer patients
Thromboembolism in hospitalized neutropenic cancer patients
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DOI：
10.1200/jco.2005.03.8877
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发表时间：
2006-01-20
影响因子：
45.3
通讯作者：
Lyman, GH
中科院分区：
文献类型：
--
作者：
Khorana, AA;Francis, CW;Lyman, GH
目的 癌症与血栓形成有关，但接受当前化疗方案的住院癌症患者的血栓栓塞频率尚不清楚。我们调查了因中性粒细胞减少症而积极接受治疗的住院癌症患者的静脉和动脉血栓栓塞及相关结果。方法我们利用大学健康系统联盟的出院数据库进行了一项回顾性队列研究。其中包括 66,106 名成年中性粒细胞减少性癌症患者，1995 年至 2002 年间在美国 115 个医疗中心住院治疗 88,074 例。 结果 5,272 名患者 (8%) 报告发生血栓栓塞，其中 5.4% 的患者在首次住院期间发生静脉血栓栓塞，1.5% 的患者发生动脉血栓栓塞。淋巴瘤和白血病患者占静脉事件的三分之一和动脉事件的近一半。与血栓栓塞最常见相关的临床变量是年龄≥65岁；癌症的原发部位，包括肺癌、胃肠道癌、妇科癌和脑癌；以及合并症，包括感染、肺病和肾病以及肥胖。静脉血栓栓塞（比值比 [OR] = 2.01；95% CI，1.83 至 2.22）或动脉血栓栓塞（OR = 5.04；95% CI，4.38 至 5.79）患者的院内死亡率显着更高。从 1995 年到 2002 年，静脉事件增加了 36%，动脉事件增加了 124%（趋势 P < .0001）。结论 血栓栓塞在住院的中性粒细胞减少癌症患者中很常见，包括在被认为是低风险的亚组中，例如患有血液系统恶性肿瘤和非转移性疾病的患者，并且血栓栓塞似乎正在增加。血栓栓塞与院内死亡率增加有关。有必要加大血栓预防的力度。
Purpose Cancer is associated with thrombosis, but the frequency of thromboembolism in hospitalized cancer patients receiving current chemotherapy regimens is not known. We investigated venous and arterial thromboembolism and associated outcomes in hospitalized cancer patients actively receiving therapy, as identified by neutropenia.Methods We conducted a retrospective cohort study using the discharge database of the University HealthSystem Consortium. This included 66,106 adult neutropenic cancer patients with 88,074 hospitalizations between 1995 and 2002 at 115 medical centers in the United States.Results Thromboembolism was reported in 5,272 patients (8%), with 5.4% patients developing venous thromboembolism and 1.5% developing arterial thromboembolism during the first hospitalization. Patients with lymphoma and leukemia accounted for one third of venous and nearly one half of arterial events. Clinical variables most frequently associated with thromboembolism were age >= 65 years; primary site of cancer, including lung, GI, gynecologic, and brain; and comorbidities, including infection, pulmonary and renal disease, and obesity. In-hospital mortality was significantly greater in patients with venous (odds ratio [OR] = 2.01; 95% CI, 1.83 to 2.22) or arterial thromboembolism (OR = 5.04; 95% CI, 4.38 to 5.79). From 1995 to 2002, there was a 36% increase in venous events and a 124% increase in arterial events (P < .0001 for trend).Conclusion Thromboembolism is frequent in hospitalized neutropenic cancer patients, including in perceived low-risk subgroups such as patients with hematologic malignancies and nonmetastatic disease, and seems to be increasing. Thromboembolism is associated with increased in-hospital mortality. Increased efforts at thromboprophylaxis are warranted.