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静脉血栓栓塞症在接受治疗后的结果在外科手术患者和急性病内科患者中有所不同。RIETE注册研究的结果。

The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry.

作者信息

Monreal M, Kakkar A K, Caprini J A, Barba R, Uresandi F, Valle R, Suarez C, Otero R

机构信息

Servico de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.

出版信息

J Thromb Haemost. 2004 Nov;2(11):1892-8. doi: 10.1111/j.1538-7836.2004.01012.x.

Abstract

BACKGROUND

The history of venous thromboembolism (VTE), and the rationale for thromboprophylaxis in surgical patients are well understood. The situation is less clear for acutely ill medical patients.

OBJECTIVES

To compare the clinical presentation of VTE and clinical outcomes of immobile acutely ill medical patients with surgical patients.

PATIENTS

RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute VTE. In this analysis, clinical characteristics of patients, details of anticoagulant therapy, and outcomes of all enrolled acutely ill medical patients with immobility >/= 4 days, and surgical patients are included.

RESULTS

Of 6160 patients enrolled up to December 2003, 756 (12%) were acutely ill medical patients with immobility >/= 4 days, and 884 (14%) were surgical patients who developed VTE within 2 months of surgical intervention. Only 28% of acutely ill medical patients had received thromboprophylaxis, compared with 67% of surgical patients. During the 3-month follow-up period, both fatal pulmonary embolism (PE) and fatal bleeding occurred more frequently in acutely ill medical patients. Immobility in acutely ill medical patients, cancer, and PE were associated with a significantly higher risk of fatal PE or bleeding.

CONCLUSIONS

In patients treated for VTE, the incidences of fatal PE, fatal bleeding, and major bleeding were significantly higher in acutely ill medical patients compared with surgical patients. Given the low percentage of acutely ill medical patients who had received thromboprophylaxis, increasing its use appropriately may reduce the incidence of VTE and associated complications.

摘要

背景

静脉血栓栓塞症(VTE)的病史以及外科手术患者进行血栓预防的基本原理已为人熟知。而对于急性病内科患者,情况则不太明确。

目的

比较急性病内科卧床患者与外科手术患者VTE的临床表现及临床结局。

患者

RIETE(静脉血栓栓塞疾病信息登记处)是一个西班牙的登记处,连续纳入经客观证实的有症状急性VTE患者。在本分析中,纳入了所有登记的活动受限≥4天的急性病内科患者以及外科手术患者的临床特征、抗凝治疗细节和结局。

结果

截至2003年12月登记的6160例患者中,756例(12%)是活动受限≥4天的急性病内科患者,884例(14%)是在外科手术干预后2个月内发生VTE的外科手术患者。只有28%的急性病内科患者接受了血栓预防,而外科手术患者这一比例为67%。在3个月的随访期内,急性病内科患者中致命性肺栓塞(PE)和致命性出血的发生率更高。急性病内科患者的活动受限、癌症和PE与致命性PE或出血的风险显著升高相关。

结论

在接受VTE治疗的患者中,急性病内科患者的致命性PE、致命性出血和大出血的发生率显著高于外科手术患者。鉴于接受血栓预防的急性病内科患者比例较低,适当增加其使用可能会降低VTE及其相关并发症的发生率。

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