White Richard H, Murin Susan
Division of General Internal Medicine, University of California, Davis, Sacramento, California 95817, USA.
Curr Opin Pulm Med. 2009 Sep;15(5):418-24. doi: 10.1097/MCP.0b013e32832d044a.
To summarize recent studies that have quantified the incidence of death due to late thromboembolic disease among patients initially diagnosed with acute unprovoked pulmonary embolism. These findings will aid clinicians who must weigh the risk versus the benefits of long-term anticoagulant therapy.
The incidence of death due to fatal acute recurrent pulmonary embolism following 3-6 months of anticoagulant therapy is approximately 0.2-0.4% per year, depending in part on the presence or absence of chronic comorbidity. In addition, up to 1-3% of all patients with pulmonary embolism are diagnosed with chronic thromboembolic pulmonary hypertension within 3 years of the index event. Patients with acute pulmonary embolism who develop acute pulmonary hypertension greater than 50 mmHg that does not resolve in the first few weeks are at highest risk for progression, particularly if the event is recurrent pulmonary embolism.
The incidence of death due to recurrent pulmonary embolism or significantly debilitating or fatal thromboembolic pulmonary hypertension in the first 3 years after anticoagulant treatment is discontinued is approximately 1-3%. In patients in whom the risk of fatal or disabling hemorrhage is lower, the benefits of chronic anticoagulation may outweigh the risks.
总结近期研究，这些研究对最初诊断为急性特发性肺栓塞患者中因晚期血栓栓塞性疾病导致的死亡发生率进行了量化。这些发现将有助于临床医生权衡长期抗凝治疗的风险与益处。
抗凝治疗3至6个月后，因致命性急性复发性肺栓塞导致的死亡发生率约为每年0.2%至0.4%，部分取决于是否存在慢性合并症。此外，在索引事件发生3年内，所有肺栓塞患者中高达1%至3%被诊断为慢性血栓栓塞性肺动脉高压。急性肺栓塞患者若出现急性肺动脉高压且大于50 mmHg，在最初几周内未缓解，则进展风险最高，尤其是当事件为复发性肺栓塞时。
抗凝治疗停止后的前3年，因复发性肺栓塞或严重致残或致命性血栓栓塞性肺动脉高压导致的死亡发生率约为1%至3%。在致命性或致残性出血风险较低的患者中，长期抗凝的益处可能超过风险。
