Lindhoff-Last E
Schwerpunktes Angiologie/Hämostaseologie, Medizinische Klinik III, Johann-Wolfgang-Goethe-Universitätsklinik FrankfurtTheodor-Stern-Kai 7, 60590 Frankfurt.
Hamostaseologie. 2011 Feb;31(1):7-12; quiz 13. doi: 10.5482/ha-1144. Epub 2010 Dec 9.
Recurrent venous thromboembolism is associated with increased mortality in 5-9% of the patients. On the other hand prolonged anticoagulation can increase the bleeding risk which can also be responsible for an increased mortality. Therefore, it is necessary to validate the recurrence risk of venous thromboembolism on an individual basis. In this review the most relevant risk factors for recurrent venous thromboembolism are analyzed. Spontaneous thrombosis is associated with significantly increased recurrence rates in comparison to risk associated venous thrombosis. In addition, a positive D-dimer result after stop of anticoagulation, an increased amount of residual thrombus in proximal veins analyzed by compression sonography, a proximal localization of thrombosis, symptomatic pulmonary embolism and male sex are clinically relevant risk factors for increased recurrence rates. While mild thrombophilic defects like heterozygous factor V Leiden mutation are not associated with a clinically relevant recurrence risk, inherited inhibitor deficiencies and the antiphospholipid-syndrome are known to be responsible for an increased recurrence rate of venous thromboembolism. A new recurrence risk-score (RR-Score) for individual judgement of patients with a first spontaneous venous thrombosis is introduced.
复发性静脉血栓栓塞症在5%至9%的患者中与死亡率增加相关。另一方面，长期抗凝会增加出血风险，这也可能导致死亡率上升。因此，有必要基于个体情况来验证静脉血栓栓塞症的复发风险。在本综述中，分析了复发性静脉血栓栓塞症最相关的危险因素。与风险相关性静脉血栓形成相比，自发性血栓形成与复发率显著增加相关。此外，抗凝治疗停止后D - 二聚体结果呈阳性、通过压迫超声检查分析发现近端静脉残余血栓量增加、血栓形成的近端定位、症状性肺栓塞以及男性性别都是复发率增加的临床相关危险因素。虽然轻度血栓形成倾向缺陷如杂合子因子V Leiden突变与临床相关的复发风险无关，但遗传性抑制剂缺乏和抗磷脂综合征已知会导致静脉血栓栓塞症复发率增加。本文介绍了一种用于对首次自发性静脉血栓形成患者进行个体评估的新复发风险评分（RR - 评分）。
