University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada.
Ann Intern Med. 2010 May 4;152(9):578-89. doi: 10.7326/0003-4819-152-9-201005040-00008.
Case-fatality rates are important for assessing the risks and benefits of anticoagulation in patients with venous thromboembolism (VTE).
To summarize case-fatality rates of recurrent VTE and major bleeding events during anticoagulation and recurrent VTE after anticoagulation.
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and all evidence-based medicine reviews in the Ovid interface through the second quarter of 2008.
69 articles (13 prospective cohort studies and 56 randomized, controlled trials) that reported on patients with symptomatic VTE who received anticoagulation therapy for at least 3 months and on the rate of fatal recurrent VTE and fatal major bleeding.
Two reviewers independently extracted data onto standardized forms.
During the initial 3 months of anticoagulation, the rate of recurrent fatal VTE was 0.4% (95% CI, 0.3% to 0.6%), with a case-fatality rate of 11.3% (CI, 8.0% to 15.2%). The rate of fatal major bleeding events was 0.2% (CI, 0.1% to 0.3%), with a case-fatality rate of 11.3% (CI, 7.5% to 15.9%). After anticoagulation, the rate of fatal recurrent VTE was 0.3 per 100 patient-years (CI, 0.1% to 0.4%), with a case-fatality rate of 3.6% (CI, 1.9% to 5.7%).
Estimates come from heterogeneous trial and cohort populations and are not derived from patient-level longitudinal data. Differences in case-fatality rates during and after anticoagulation may be attributable to unmeasured patient characteristics.
The case-fatality rates of recurrent VTE and major bleeding events are similar during the initial period of VTE treatment. The case-fatality rate of recurrent VTE decreases after completion of the initial period of anticoagulation. When combined with absolute rates of recurrent VTE and major bleeding events, case-fatality rates provide clinicians with a surrogate measure of mortality to balance the risks and benefits of anticoagulant therapy in patients with VTE.
Canadian Institute for Health Research and Heart and Stroke Foundation of Ontario.
病死率对于评估静脉血栓栓塞症（VTE）患者抗凝治疗的风险和获益非常重要。
总结抗凝治疗期间和抗凝治疗后复发性 VTE 及大出血事件、复发性 VTE 的病死率。
MEDLINE、EMBASE、Cochrane 对照试验中心注册库以及 2008 年第二季度之前在 Ovid 界面中的所有循证医学评价。
69 篇文章（13 项前瞻性队列研究和 56 项随机对照试验），报道了接受抗凝治疗至少 3 个月且有症状性 VTE 的患者的病死率，以及复发性致命性 VTE 和致命性大出血的发生率。
两名评审员独立将数据提取到标准表格中。
抗凝治疗的最初 3 个月内，复发性致命性 VTE 的发生率为 0.4%（95%CI，0.3%至 0.6%），病死率为 11.3%（CI，8.0%至 15.2%）。致命性大出血事件的发生率为 0.2%（CI，0.1%至 0.3%），病死率为 11.3%（CI，7.5%至 15.9%）。抗凝治疗后，复发性致命性 VTE 的发生率为每 100 患者-年 0.3 例（CI，0.1%至 0.4%），病死率为 3.6%（CI，1.9%至 5.7%）。
这些估计值来自于异质性的试验和队列人群，并非源自于患者水平的纵向数据。抗凝治疗期间和之后病死率的差异可能归因于未测量的患者特征。
在 VTE 治疗的初始阶段，复发性 VTE 和大出血事件的病死率相似。抗凝治疗初始阶段结束后，复发性 VTE 的病死率下降。当与复发性 VTE 和大出血事件的绝对发生率相结合时，病死率为临床医生提供了一种替代死亡率的衡量指标，以平衡 VTE 患者抗凝治疗的风险和获益。
加拿大卫生研究院和安大略省心脏和中风基金会。
