Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis.
Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis.
复制标题
DOI：
10.3389/fcvm.2021.698336
复制
发表时间：
2021
影响因子：
3.6
通讯作者：
Westerink J
中科院分区：
文献类型：
--
作者：
Duijzer D;de Winter MA;Nijkeuter M;Tuinenburg AE;Westerink J
目的：心脏装置治疗中经静脉导联的存在可能会增加静脉血栓栓塞的风险。这些并发症的流行病学尚未系统地确定。因此，本研究旨在确定(I)经静脉导联患者在导线植入后最初2个月的症状性上肢深静脉血栓（UEDVT）发生率和（II）无症状性上肢静脉闭塞发生率。方法：检索PubMed、EMBASE和Cochrane图书馆，直到2020年3月31日，以确定报道经静脉导联成人患者植入后最初2个月后UEDVT发生率和无症状静脉闭塞发生率的研究。计算每100患者随访年的发病率（PY）和比例（%），以得出发病率和患病率的汇总估计。结果：检索和选择分别获得20篇和24篇关于UEDVT和无症状静脉闭塞的研究报告。在铅植入2个月后，UEDVT的总总发生率为0.9 (95% CI 0.5-1.4) / 100PY。研究之间存在高度的统计异质性（I2 = 82.4%; P = < 0.001），只有3项研究被认为是低偏倚风险。无症状上肢静脉闭塞的总体合并患病率为8.6% (95% CI 6.0-11.5)，异质性高（I2 = 81.4%; P = <0.001）。meta回归分析显示，更多的导联与更高的UEDVT风险相关。结论：经静脉导联是症状性UEDVT的重要危险因素，可能在首次植入导联多年后发生。现有的关于铅植入后UEDVT的数据大多质量较差，这强调了高质量的前瞻性研究的必要性。无症状静脉闭塞存在于相当比例的患者中，并可能使任何未来的铅添加复杂化。临床试验注册：（URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178136，标识符：PROSPERO 2020 CRD42020178136）。
Aims: The presence of transvenous leads for cardiac device therapy may increase the risk of venous thromboembolisms. The epidemiology of these complications has not yet been determined systematically. Therefore, this study aims to determine (I) the incidence of symptomatic upper extremity deep vein thrombosis (UEDVT) and (II) the prevalence of asymptomatic upper extremity vein occlusion in patients with transvenous leads, both after the initial 2 months following lead implantation. Methods: PubMed, EMBASE, and Cochrane Library were searched until March 31, 2020 to identify studies reporting incidence of UEDVT and prevalence of asymptomatic vein occlusion after the initial 2 months after implantation in adult patients with transvenous leads. Incidence per 100 patient years of follow-up (PY) and proportions (%) were calculated to derive pooled estimates of incidence and prevalence. Results: Search and selection yielded 20 and 24 studies reporting on UEDVT and asymptomatic vein occlusion, respectively. The overall pooled incidence of UEDVT was 0.9 (95% CI 0.5–1.4) per 100PY after 2 months after lead implantation. High statistical heterogeneity was present among studies (I2 = 82.4%; P = < 0.001) and only three studies considered to be at low risk of bias. The overall pooled prevalence of asymptomatic upper extremity vein occlusion was 8.6% (95% CI 6.0–11.5) with high heterogeneity (I2 = 81.4%; P = <0.001). Meta-regression analysis showed more leads to be associated with a higher risk of UEDVT. Conclusion: Transvenous leads are an important risk factor for symptomatic UEDVT, which may occur up to multiple years after initial lead implantation. Existing data on UEDVT after lead implantation is mostly of poor quality, which emphasizes the need for high quality prospective research. Asymptomatic vein occlusion is present in a substantial proportion of patients and may complicate any future lead addition. Clinical Trial Registration: (URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178136, Identifier: PROSPERO 2020 CRD42020178136).