Bova Carlo, Marchiori Antonio, Noto Alfonso, Rossi Vincenza, Daniele Filomena, Santoro Caterina, Ricchio Roberto, De Lorenzo Roberto, Umbaca Rossella, Prandoni Paolo
Department of Medicine, Azienda Ospedaliera, Cosenza, Italy.
Thromb Haemost. 2006 Aug;96(2):132-6.
Recent data have shown a higher incidence of arterial events in patients with venous thromboembolism (VTE) of unknown origin than in those with the secondary form of disease. Whether patients with idiopathic VTE have a higher risk of subsequent arterial events than the general population is unknown. The aim was to evaluate the rates of subsequent arterial events in patients with idiopathic VTE and control subjects. In a retrospective cohort study we compared the rates of subsequent arterial events (i.e. acute myocardial infarction, ischemic stroke and peripheral arterial disease) in 151 consecutive patients with objectively confirmed spontaneous VTE and 151 control subjects randomly selected from the database of two family physicians. We collected information about cardiovascular risk-factors (hypertension, hypercholesterolemia, diabetes, obesity and smoke) at the time of VTE episode, or corresponding date for the controls, and considered the follow-up from this time. Patients and controls who had suffered from arterial events before the index date were excluded. During a mean follow-up of 43.1 (+/- 21.7) months there were 16 arterial events in the VTE patients and six in the control group (HR, 2.84;95% CI,1.11 to 7.27; p = 0.03). The difference remained significant after adjusting for age and other cardiovascular risk factors (HR 2.86;95% CI,1.07 to 7.62). Overall mortality was also higher in the VTE patients (12 vs.4 deaths). In conclusion, arterial events are more common in patients with previous idiopathic VTE than in the general population. These findings may have practical implications.
近期数据显示，不明原因静脉血栓栓塞（VTE）患者发生动脉事件的发生率高于继发性疾病患者。特发性VTE患者随后发生动脉事件的风险是否高于普通人群尚不清楚。目的是评估特发性VTE患者和对照者随后发生动脉事件的发生率。在一项回顾性队列研究中，我们比较了151例经客观证实的自发性VTE连续患者和从两名家庭医生数据库中随机选取的151例对照者随后发生动脉事件（即急性心肌梗死、缺血性卒中和外周动脉疾病）的发生率。我们收集了VTE发作时或对照者相应日期的心血管危险因素（高血压、高胆固醇血症、糖尿病、肥胖和吸烟）信息，并从此时开始进行随访。排除在索引日期之前发生过动脉事件的患者和对照者。在平均43.1（±21.7）个月的随访期间，VTE患者中有16例发生动脉事件，对照组中有6例（风险比，2.84；95%可信区间，1.11至7.27；P = 0.03）。在调整年龄和其他心血管危险因素后，差异仍然显著（风险比2.86；95%可信区间，1.07至7.62）。VTE患者的总体死亡率也更高（12例死亡对4例死亡）。总之，既往有特发性VTE的患者发生动脉事件比普通人群更常见。这些发现可能具有实际意义。
