Rosencher J, Mirault T, Martinez I, Zhu T, Messas E, Emmerich J
Unité Inserm U765, université Paris Descartes, faculté de médecine, 75508 Paris cedex, France.
Rev Mal Respir. 2011 Apr;28(4):453-62. doi: 10.1016/j.rmr.2010.10.036. Epub 2011 Mar 21.
Recurrent venous thromboembolism (VTE) is frequent and can be fatal. Long-term antithrombotic treatment reduces the risk of recurrent VTE but increases the risk of bleeding and, therefore, cannot be proposed for all patients. Predicting the probability of recurrence in an individual patient is of utmost importance for assessing the risk-benefit ratio of long-term anticoagulation. Multiple clinical risk factors for recurrent VTE have been identified which include: unprovoked first episode, anatomical proximal location, male gender, residual venous thrombosis, cancer and antiphospholipid syndrome. d-dimer level after discontinuation of oral anticoagulation can help to predict the risk of recurrence with a good negative predictive value. Finally, genetic polymorphisms and rare inherited deficiencies of natural anticoagulant proteins do not seem to be strongly associated to recurrence. New antithrombotic drugs may, in the near future, improve the safety and of long-term anticoagulation treatment.
复发性静脉血栓栓塞（VTE）很常见且可能致命。长期抗血栓治疗可降低复发性VTE的风险，但会增加出血风险，因此，不能对所有患者都建议进行该治疗。预测个体患者复发的可能性对于评估长期抗凝治疗的风险效益比至关重要。已确定了复发性VTE的多个临床风险因素，包括：首次发作无诱因、解剖学上的近端位置、男性、残留静脉血栓形成、癌症和抗磷脂综合征。停用口服抗凝药后的D-二聚体水平有助于预测复发风险，具有良好的阴性预测价值。最后，天然抗凝蛋白的基因多态性和罕见遗传性缺陷似乎与复发没有密切关联。在不久的将来，新型抗血栓药物可能会提高长期抗凝治疗的安全性。
