Hron G, Eichinger S, Weltermann A, Quehenberger P, Halbmayer W M, Kyrle P A
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
J Thromb Haemost. 2006 Apr;4(4):752-6. doi: 10.1111/j.1538-7836.2006.01868.x.
Venous thromboembolism (VTE) is a multi-factorial disease. Extensive thrombophilia screening is costly and often inconclusive. Simple laboratory methods are required to predict the risk of recurrence.
To assess if measurement of activated partial thromboplastin time (APTT) allows stratification of patients with VTE into high- and low-risk categories with regard to recurrence.
We prospectively followed 918 patients with a first unprovoked VTE and studied the relationship between recurrence and an APTT after discontinuation of anticoagulation. APTT was expressed as a ratio of test to reference coagulation times. Study endpoint was symptomatic recurrent VTE.
Venous thromboembolism recurred in 101 (11%) patients. Patients without recurrence had a greater APTT ratio than those with recurrence (0.97 +/- 0.09 vs. 0.93 +/- 0.09, P = 0.001). After 4 years, probability of recurrent VTE was 8.5% (95% CI: 5.5-11.5%) among patients with a ratio equal to or > 0.95 and 15.6% (95% CI: 11.4-19.9%) among patients with a lower ratio (P = 0.005). Compared with patients with an APTT ratio < 0.95, the relative risk (RR) of recurrence among patients with a ratio equal to or > 0.95 was 0.56 (95% CI: 0.38-0.84, P = 0.005) before and 0.58 (95% CI: 0.39-0.87, P = 0.009) after adjustment for sex, age, factor V Leiden, and factor II G20210A.
Measurement of APTT allows stratification of patients with VTE into high- and low-risk categories with regard to recurrence.
静脉血栓栓塞症（VTE）是一种多因素疾病。广泛的血栓形成倾向筛查成本高昂且往往无定论。需要简单的实验室方法来预测复发风险。
评估活化部分凝血活酶时间（APTT）的测定是否能将VTE患者按复发风险分为高风险和低风险类别。
我们前瞻性地随访了918例首次发生特发性VTE的患者，并研究了抗凝治疗中断后复发与APTT之间的关系。APTT以检测凝血时间与对照凝血时间的比值表示。研究终点为有症状的复发性VTE。
101例（11%）患者发生了静脉血栓栓塞复发。未复发患者的APTT比值高于复发患者（0.97±0.09对0.93±0.09，P = 0.001）。4年后，APTT比值等于或大于0.95的患者中复发性VTE的概率为8.5%（95%CI：5.5 - 11.5%），比值较低的患者中为15.6%（95%CI：11.4 - 19.9%）（P = 0.005）。与APTT比值<0.95的患者相比，APTT比值等于或大于0.95的患者复发的相对风险（RR）在调整性别、年龄、凝血因子V Leiden和凝血因子II G20210A之前为0.56（95%CI：0.38 - 0.84，P = 0.005），调整后为0.58（95%CI：0.39 - 0.87，P = 0.009）。
APTT的测定可将VTE患者按复发风险分为高风险和低风险类别。
