Ageno Walter, Agnelli Giancarlo, Imberti Davide, Moia Marco, Palareti Gualtiero, Pistelli Riccardo, Rossi Romina, Verso Melina
University of Insubria, Ospedale di Crcolo, Viale Borri 57, Varese, Italy.
Blood Coagul Fibrinolysis. 2008 Oct;19(7):663-7. doi: 10.1097/MBC.0b013e3283079e58.
Approximately 50-75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence and the relative weight of major risk factors differ between elderly and younger patients is unclear. We performed a multicenter, prospective, observational study on consecutive patients with objectively confirmed acute venous thromboembolism admitted to 25 Italian hospitals. Baseline characteristics and information on temporary and permanent risk factors at the time of the index event were secured by an electronic data network. We enrolled 2119 patients (49.8% men), of whom 440 (20%) were more than 75 years of age and 1679 (79.2%) 75 years of age or less. Elderly patients were more likely to have pulmonary embolism at presentation (33.6 and 25.6%, respectively, P < 0.001). After binary logistic regression analysis, we found that the risk of venous thromboembolism in the elderly, compared with the younger age group, was significantly associated with immobilization (odds ratio: 2.46, 95% confidence interval: 1.85-3.27) and with severe medical disorders (odds ratio: 1.99, 95% confidence interval: 1.41-2.80), whereas male sex (odds ratio: 0.53, 95% confidence interval: 0.42-0.66), surgery (odds ratio: 0.61, 95% confidence interval: 0.43-0.85), and trauma (odds ratio: 0.49, 95% confidence interval: 0.31-0.77) were less common risk factors in the elderly than in younger patients. Use of thromboprophylaxis prior to the index event was not different between the two age groups. Severe medical disorders and immobilization are strongly associated with the occurrence of venous thromboembolism in the elderly. Our findings stress the need for adequate thromboprophylaxis in this setting.
约50% - 75%的静脉血栓栓塞患者有一个易于识别的危险因素，该因素可以是短暂的或永久的，而其余发作被归类为特发性。首次静脉血栓栓塞的发病率随年龄呈指数上升。老年患者和年轻患者之间主要危险因素的患病率和相对权重是否不同尚不清楚。我们对意大利25家医院收治的经客观证实的急性静脉血栓栓塞连续患者进行了一项多中心、前瞻性观察研究。通过电子数据网络获取基线特征以及索引事件发生时临时和永久危险因素的信息。我们纳入了2119例患者（49.8%为男性），其中440例（20%）年龄超过75岁，1679例（79.2%）年龄在75岁及以下。老年患者就诊时更易发生肺栓塞（分别为33.6%和25.6%，P < 0.001）。经过二元逻辑回归分析，我们发现与年轻年龄组相比，老年患者发生静脉血栓栓塞的风险与制动（比值比：2.46，95%置信区间：1.85 - 3.27）和严重内科疾病（比值比：1.99，95%置信区间：1.41 - 2.80）显著相关，而男性（比值比：0.53，95%置信区间：0.42 - 0.66）、手术（比值比：0.61，95%置信区间：0.43 - 0.85）和创伤（比值比：0.49，95%置信区间：0.31 - 0.77）在老年患者中是比年轻患者更少见的危险因素。索引事件发生前预防性使用血栓药物在两个年龄组之间没有差异。严重内科疾病和制动与老年患者静脉血栓栓塞的发生密切相关。我们的研究结果强调了在这种情况下进行充分血栓预防的必要性。
