Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The CVRN VTE Study
Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The CVRN VTE Study
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急性肺栓塞和深静脉血栓形成的治疗和结局：CVRN VTE研究
DOI：
10.1016/j.amjmed.2019.05.040
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发表时间：
2019-12-01
影响因子：
5.9
通讯作者：
Go, Alan S.
中科院分区：
文献类型：
--
作者：
Fang, Margaret C.;Fan, Dongjie;Go, Alan S.
背景：在美国，很少有研究描述急性静脉血栓栓塞患者的住院和门诊治疗和预后。方法：从美国4个大型综合医疗保健系统中建立了2004年至2010年间确诊为肺栓塞或深静脉血栓形成的多机构队列。访问计算机数据库并审查医疗记录，以收集有关患者人口统计学、临床危险因素、初始抗血栓治疗和生命状态的信息。采用多变量Cox回归模型估计90天死亡风险。结果：该队列包括5497名患有急性静脉血栓栓塞的成年人。肺栓塞主要在医院治疗（95.0%），而54.5%的下肢血栓患者在门诊治疗。抗凝治疗因血栓栓塞类型不同而不同：肺栓塞患者2688例（92.8%），下肢血栓患者1625例（86.9%），而上肢血栓患者286例（80.1%），其他血栓患者69例（54.8%）。4.5%的患者在指数发作期间死亡，15.4%的患者在90天内死亡。与下肢血栓形成相比，肺栓塞的90天死亡风险更高（校正风险比1.23,95%可信区间1.04-1.47），未使用抗凝剂出院的肺栓塞的90天死亡风险更高（校正风险比5.56,95%可信区间4.76-6.67）。结论：在这项多中心、以社区为基础的急性静脉血栓栓塞患者研究中，抗凝治疗和结果因血栓栓塞类型而异。尽管急性发作期间的病死率相对较低，但15.4%的血栓栓塞患者在指标诊断后90天内死亡。(C) 2019 Elsevier Inc.版权所有。
BACKGROUND: Few studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the United States.METHODS: A multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism or deep venous thrombosis during the years 2004 through 2010 was established from 4 large, US-based integrated health care delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90 days.RESULTS: The cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%), while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2688 patients (92.8%) with pulmonary embolism and 1625 patients (86.9%) with lower extremity thrombosis were discharged on anticoagulants, compared with 286 patients (80.1%) with upper extremity thrombosis and 69 (54.8%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90 days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio 1.23; 95% confidence interval, 1.04-1.47), as was not being discharged on anticoagulants (adjusted hazard ratio 5.56; 95% confidence interval, 4.76-6.67).CONCLUSIONS: In this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90 days of the index diagnosis. (C) 2019 Elsevier Inc. All rights reserved.