Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Hematology Am Soc Hematol Educ Program. 2009:259-66. doi: 10.1182/asheducation-2009.1.259.
Venous and arterial thromboses have traditionally been considered distinct pathophysiologic entities. However, the two disorders have many features in common, and there is evidence that persons with venous thrombosis may be at greater risk for arterial events. The pathogenesis of both disorders includes endothelial injury, platelet activation, elevated levels of intrinsic clotting factors and inflammatory markers, increased fibrinogen, and impaired fibrinolysis. In addition, older age, obesity, dyslipidemia, and smoking predispose to both venous and arterial thrombosis. While the evidence that arterial disease is a risk factor for venous thrombosis is inconclusive, arterial disease does appear to occur with a modestly increased frequency in patients with a history of venous thromboembolism. Reported odds ratios in such patients were 1.2 for myocardial infarction, 1.3 for stroke, 2.3 for carotid plaque, and 4.3 for coronary calcification. Of note, in persons under age 40 with unprovoked venous thrombosis, the odds ratio for acute myocardial infarction was as high as 3.9. In general, however, venous disease is considered to be a weak risk factor for arterial thrombosis, and the use of agents specifically targeted to the prevention of heart attack or stroke in the majority of persons with VTE cannot be recommended at present.
静脉血栓和动脉血栓形成传统上被认为是两种截然不同的病理生理实体。然而，这两种疾病有许多共同的特征，有证据表明静脉血栓形成的患者可能有更大的动脉事件风险。两种疾病的发病机制都包括内皮损伤、血小板激活、内在凝血因子和炎症标志物水平升高、纤维蛋白原增加和纤维蛋白溶解受损。此外，年龄较大、肥胖、血脂异常和吸烟使静脉和动脉血栓形成的风险增加。虽然动脉疾病是静脉血栓形成的危险因素的证据尚无定论，但在有静脉血栓栓塞史的患者中，动脉疾病的发生频率似乎略有增加。在这些患者中，心肌梗死的报告比值比为 1.2，中风为 1.3，颈动脉斑块为 2.3，冠状动脉钙化为 4.3。值得注意的是，在无诱因静脉血栓形成的 40 岁以下人群中，急性心肌梗死的比值比高达 3.9。然而，一般来说，静脉疾病被认为是动脉血栓形成的一个较弱的危险因素，目前不能推荐在大多数 VTE 患者中使用专门针对预防心脏病发作或中风的药物。
