Kikura Mutsuhito, Takada Tomosue, Sato Shigehito
Department of Anesthesiology and Pain Clinic, Seirei-Mikatabara General Hospital, Mikatabara-cho 3453, Hamamatsu, Japan.
Thromb Haemost. 2004 Apr;91(4):725-32. doi: 10.1160/TH03-10-0613.
We investigated age- and sex-specific incidence, risk factors, and latency period of a perioperative acute thromboembolism syndrome (PATS) in a large cohort study. We prospectively analyzed data on 21903 consecutive surgery patients to determine the incidence of myocardial infarction, pulmonary embolism, deep venous thrombosis, stroke, and cardiovascular death within 30 postoperative days. Among 255 (1.2 percent) patients with thromboembolism, 105 (0.48 percent) suffered myocardial infarction (mean latency: 5 days), 30 (0.14 percent) suffered pulmonary embolism (6 days), 23 (0.11 percent) suffered deep venous thrombosis (10 days), 97 (0.44 percent) suffered stroke (11 days), and 13 (0.06 percent) died (12 days). The critical period was postoperative week 1 for myocardial infarction and pulmonary embolism, and postoperative week 1 and 2 for deep venous thrombosis, stroke, and death. Risk of all events increased with age (P<0.0001), particularly for over 70 years (odds ratio: 12.5; 95 percent confidence interval, 7.8 to 19.9). Males had an increased risk (P<0.0001) of myocardial infarction (odds ratio; 1.5; 95 percent confidence interval, 1.0 to 2.3). Females had an increased risk (P<0.0001) of pulmonary embolism (odds ratio: 2.7; 95 percent confidence interval, 1.3 to 5.9) and deep venous thrombosis (odds ratio: 9.8; 95 percent confidence interval, 3.3 to 29.3). Risk of thromboembolic event was higher (P<0.0001) in patients with a history of arterial thrombotic events or cancer. Trend analysis indicates that thromboembolic events will increase 3-fold over the next decade. Our findings enable identification of higher risk patients for prophylactic anti-thromboembolic treatment and awareness of the critical postoperative period.
在一项大型队列研究中，我们调查了围手术期急性血栓栓塞综合征（PATS）的年龄和性别特异性发病率、危险因素及潜伏期。我们对21903例连续手术患者的数据进行了前瞻性分析，以确定术后30天内心肌梗死、肺栓塞、深静脉血栓形成、中风及心血管死亡的发生率。在255例（1.2%）发生血栓栓塞的患者中，105例（0.48%）发生心肌梗死（平均潜伏期：5天），30例（0.14%）发生肺栓塞（6天），23例（0.11%）发生深静脉血栓形成（10天），97例（0.44%）发生中风（11天），13例（0.06%）死亡（12天）。心肌梗死和肺栓塞的关键时期为术后第1周，深静脉血栓形成、中风和死亡的关键时期为术后第1周和第2周。所有事件的风险均随年龄增加而升高（P<0.0001），70岁以上人群尤为明显（比值比：12.5；95%置信区间，7.8至19.9）。男性发生心肌梗死的风险增加（P<0.0001）（比值比：1.5；95%置信区间，1.0至2.3）。女性发生肺栓塞（比值比：2.7；95%置信区间，1.3至5.9）和深静脉血栓形成（比值比：9.8；95%置信区间，3.3至29.3）的风险增加（P<0.0001）。有动脉血栓事件或癌症病史患者发生血栓栓塞事件的风险更高（P<0.0001）。趋势分析表明，未来十年血栓栓塞事件将增加两倍。我们的研究结果有助于识别需要预防性抗血栓栓塞治疗的高危患者，并提高对术后关键时期的认识。
