Mello Tayana B T, Orsi Fernanda L A, Montalvao Silmara A L, Ozelo Margareth C, de Paula Erich V, Annichinno-Bizzachi Joyce M
Hematology and Hemotherapy Center, State University of Campinas, Campinas, Sao Paulo, Brazil.
Blood Coagul Fibrinolysis. 2010 Oct;21(7):660-5. doi: 10.1097/MBC.0b013e32833ceaef.
The aim of this study was to assess the incidence and risk factors for recurrent venous thromboembolism (VTE) in a Hispanic population. We prospectively followed 343 patients after a first episode of objectively proven VTE. We excluded all patients with VTE at unusual sites, older than 70 years old, with neoplasia, liver or renal chronic disease and antiphospholipid syndrome. Predictors for recurrence were evaluated by Cox model. The probability of recurrent VTE was estimated by the method of Kaplan-Meier. The cumulative probability of recurrent VTE was 19.1% in 5 years and 30.0% in 10 years. Male sex [relative risk (RR) 1.7, 95% confidence interval (CI) 1.0-2.8], spontaneous first VTE (RR 2.9, 95% CI 1.7-5.0) and FII G20210A mutation (RR 4.2, 95% CI 1.9-9.4) were independent risk factors for recurrent VTE. The fibrinogen, coagulation factors VIII, IX, X and XI were measured in 200 patients and were not associated to thrombotic recurrence risk. This study indicates that the incidence of recurrent VTE is high in Hispanics and depends on clinical and laboratory findings. In this population, FII G20210A mutation may represent a specific risk factor for recurrence. The inclusion of different ethnic populations in epidemiological studies of VTE as well as new approaches to the management of anticoagulation therapy in Hispanics is warranted.
本研究的目的是评估西班牙裔人群中复发性静脉血栓栓塞症（VTE）的发生率及危险因素。我们对343例首次发生经客观证实的VTE患者进行了前瞻性随访。我们排除了所有在不寻常部位发生VTE、年龄大于70岁、患有肿瘤、肝脏或肾脏慢性疾病以及抗磷脂综合征的患者。通过Cox模型评估复发的预测因素。采用Kaplan-Meier方法估计复发性VTE的概率。复发性VTE的累积概率在5年时为19.1%，在10年时为30.0%。男性[相对风险（RR）1.7，95%置信区间（CI）1.0 - 2.8]、自发性首次VTE（RR 2.9，95% CI 1.7 - 5.0）和凝血因子II G20210A突变（RR 4.2，95% CI 1.9 - 9.4）是复发性VTE的独立危险因素。对200例患者检测了纤维蛋白原、凝血因子VIII、IX、X和XI，其与血栓形成复发风险无关。本研究表明，西班牙裔人群中复发性VTE的发生率较高，且取决于临床和实验室检查结果。在该人群中，凝血因子II G20210A突变可能是复发的一个特定危险因素。有必要将不同种族人群纳入VTE的流行病学研究，并采用新的方法对西班牙裔人群进行抗凝治疗管理。
