Matta Fadi, Singala Ravinder, Yaekoub Abdo Y, Najjar Reiad, Stein Paul D
Saint Joseph Mercy Oakland, 44405 Woodward Avenue, Pontiac, MI 48341-5023, USA.
Thromb Haemost. 2009 Jan;101(1):134-8.
Rheumatoid arthritis is not generally considered to be a risk factor for venous thromboembolism (VTE), although abnormalities of coagulation factors have been found in patients with rheumatoid arthritis. Sparse data in a few patients suggest that patients with rheumatoid arthritis may have higher rates of VTE. The purpose of this investigation was to determine if the incidences of pulmonary embolism (PE) and deep venous thrombosis (DVT) are increased in hospitalized patients with rheumatoid arthritis. The number of patients discharged from non-Federal short-stay hospitals throughout the United States from 1979 through 2005 with a discharge code for rheumatoid arthritis was obtained from the National Hospital Discharge Survey (NHDS). Among hospitalized patients with rheumatoid arthritis who did not have joint surgery, 41,000 of 4,818,000 (0.85%) had PE compared with 3,366,000 of 891,055,000 (0.38%) among patients who did not have rheumatoid arthritis and who did not have operations or joint surgery (relative risk = 2.25). Deep venous thrombosis was diagnosed in 79,000 of 4,818,000 (1.64%) patients with rheumatoid arthritis and no joint operation, versus 7,681,000 of 891,055,000 (0.86%) who did not have rheumatoid arthritis or a joint operation (relative risk = 1.90). The relative risk of venous thromboembolism (PE and/or DVT) in these patients was 1.99. The data suggest that rheumatoid arthritis is a risk factor for VTE in hospitalized medical patients. A heightened awareness of the risks for VTE and a lower threshold for evaluation of patients for possible DVT or PE would be appropriate in caring for hospitalized patients with rheumatoid arthritis.
类风湿性关节炎一般不被视为静脉血栓栓塞（VTE）的危险因素，尽管在类风湿性关节炎患者中已发现凝血因子异常。少数患者的稀疏数据表明，类风湿性关节炎患者可能有更高的VTE发生率。本研究的目的是确定类风湿性关节炎住院患者中肺栓塞（PE）和深静脉血栓形成（DVT）的发生率是否增加。从1979年至2005年美国各地非联邦短期住院医院出院且出院诊断代码为类风湿性关节炎的患者数量，是从国家医院出院调查（NHDS）中获取的。在没有进行关节手术的类风湿性关节炎住院患者中，481.8万例中有4.1万例（0.85%）发生了PE，而在没有类风湿性关节炎且没有进行手术或关节手术的患者中，89105.5万例中有336.6万例（0.38%）发生了PE（相对风险 = 2.25）。在481.8万例没有进行关节手术的类风湿性关节炎患者中，有7.9万例（1.64%）被诊断为深静脉血栓形成，而在没有类风湿性关节炎或关节手术的89105.5万例患者中，有768.1万例（0.86%）被诊断为深静脉血栓形成（相对风险 = 1.90）。这些患者发生静脉血栓栓塞（PE和/或DVT）的相对风险为1.99。数据表明，类风湿性关节炎是内科住院患者发生VTE的危险因素。在护理类风湿性关节炎住院患者时，提高对VTE风险的认识并降低对可能发生DVT或PE患者的评估阈值是合适的。
