Department of Intensive Care Medicine and School of Population Health, Royal Perth Hospital and University of Western Australia, Perth, Australia.
J Thromb Haemost. 2012 Sep;10(9):1768-74. doi: 10.1111/j.1538-7836.2012.04846.x.
It is uncertain whether reactive thrombocytosis is associated with an increased risk of venous thromboembolism. This study assessed the incidence of reactive thrombocytosis, defined as platelet count ≥ 500 × 10(9) L(-1) , at intensive care unit discharge and its association with subsequent venous thromboembolism.
This cohort study involved linkage of routinely collected intensive care unit, laboratory, radiology and death registry data of critically ill patients admitted to the intensive care unit between January 2009 and March 2010. The census date for survival and radiologically confirmed venous thromboembolism was 31 October 2011. Of the 1446 patients who survived to intensive care unit discharge, 139 patients had reactive thrombocytosis (9.6%, 95% confidence interval [CI] 8.2-11.2%). Twenty-nine patients developed venous thromboembolism after discharge (2%, 95% CI 1.4-2.9%; 67 per 100 person-years, 95% CI 45-97) and the median time to develop venous thromboembolism was 25 days (interquartile range 8-148). Reactive thrombocytosis was associated with an increased risk of subsequent venous thromboembolism (hazard ratio 5.3, 95% CI 1.7-16.4), after adjusting for other covariates. Platelet counts explained about 34% of the variability in the risk of venous thromboembolism and had a relatively linear relationship with the risk of venous thromboembolism when the platelet counts were > 400 × 10(9) L(-1) . Venous thromboembolism after intensive care unit discharge was associated with an increased risk of mortality (hazard ratio 2.0, 95% CI 1.1-3.9), after adjusting for reactive thrombocytosis.
Reactive thrombocytosis during the recovery phase of critical illness was associated with an increased risk of subsequent venous thromboembolism.
目前尚不确定反应性血小板增多症是否与静脉血栓栓塞风险增加有关。本研究评估了 ICU 出院时反应性血小板增多症（血小板计数≥500×10(9) /L）的发生率及其与随后静脉血栓栓塞的关系。
本队列研究涉及 2009 年 1 月至 2010 年 3 月期间入住 ICU 的危重病患者的常规 ICU、实验室、放射学和死亡登记数据的链接。生存和放射学确诊静脉血栓栓塞的截止日期为 2011 年 10 月 31 日。在存活至 ICU 出院的 1446 名患者中，有 139 名患者发生反应性血小板增多症（9.6%，95%置信区间[CI]8.2-11.2%）。出院后有 29 名患者发生静脉血栓栓塞（2%，95%CI 1.4-2.9%；67 例/100 人年，95%CI 45-97），发病中位时间为 25 天（四分位间距 8-148）。在调整其他协变量后，反应性血小板增多症与随后发生静脉血栓栓塞的风险增加相关（危险比 5.3，95%CI 1.7-16.4）。血小板计数解释了静脉血栓栓塞风险变化的约 34%，当血小板计数>400×10(9) /L 时，血小板计数与静脉血栓栓塞风险呈相对线性关系。ICU 出院后发生静脉血栓栓塞与死亡率增加相关（调整反应性血小板增多症后，危险比 2.0，95%CI 1.1-3.9）。
危重病恢复期的反应性血小板增多症与随后静脉血栓栓塞风险增加有关。
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