Cushman Mary, Tsai Albert W, White Richard H, Heckbert Susan R, Rosamond Wayne D, Enright Paul, Folsom Aaron R
Department of Medicine, University of Vermont, Burlington, USA.
Am J Med. 2004 Jul 1;117(1):19-25. doi: 10.1016/j.amjmed.2004.01.018.
To determine the incidence of deep vein thrombosis and pulmonary embolism in two cohorts representing regions of the United States.
The sample comprised 21,680 participants of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study. Subjects were aged >/=45 years, resided in six communities, and were followed for 7.6 years. All hospitalizations were identified and thromboses were validated by chart review.
The age-standardized incidence of first-time venous thromboembolism was 1.92 per 1000 person-years. Rates were higher in men than women, and increased with age in both sexes. There was no antecedent trauma, surgery, immobilization, or diagnosis of cancer for 48% (175/366) of events. The 28-day case-fatality rate was 11% (29/265) after a first venous thromboembolism and 25% (17/67) for cancer-associated thrombosis. The recurrence rate 2 years after a first venous thromboembolism was 7.7% per year (95% confidence interval [CI]: 4.5% to 10.9% per year). Cancer was the only factor independently associated with 28-day fatality (relative risk [RR] = 5.2; 95% CI: 1.4 to 19.9) or recurrent thrombosis (RR = 9.2; 95% CI: 2.0 to 41.7).
The incidence of venous thromboembolism in this cohort of middle- and older-aged subjects was similar to that observed in more geographically homogeneous samples. Half of cases were idiopathic. Short-term mortality and 2-year recurrence rates were appreciable, especially among subjects with cancer. Based on this study we estimate that 187,000 cases of first-time venous thromboembolism are diagnosed yearly in the United States among those aged 45 years or older.
确定代表美国不同地区的两个队列中深静脉血栓形成和肺栓塞的发生率。
样本包括社区动脉粥样硬化风险研究和心血管健康研究的21680名参与者。受试者年龄≥45岁，居住在六个社区，随访7.6年。确定所有住院情况，并通过病历审查验证血栓形成情况。
首次静脉血栓栓塞的年龄标准化发生率为每1000人年1.92例。男性发生率高于女性，且两性发生率均随年龄增长而增加。48%（175/366）的事件无前驱创伤、手术、制动或癌症诊断。首次静脉血栓栓塞后28天的病死率为11%（29/265），癌症相关血栓形成的病死率为25%（17/67）。首次静脉血栓栓塞后2年的复发率为每年7.7%（95%置信区间[CI]：每年4.5%至10.9%）。癌症是与28天病死率（相对风险[RR]=5.2；95%CI：1.4至19.9）或复发性血栓形成（RR=9.2；95%CI：2.0至41.7）独立相关的唯一因素。
该中老年队列中静脉血栓栓塞的发生率与在地理上更同质的样本中观察到的发生率相似。一半的病例为特发性。短期死亡率和2年复发率相当可观，尤其是在癌症患者中。基于这项研究，我们估计美国45岁及以上人群中每年有187000例首次静脉血栓栓塞被诊断出来。
