Müller-Bühl Uwe, Leutgeb Rüdiger, Engeser Peter, Achankeng Edwane N, Szecsenyi Joachim, Laux Gunter
Department of General Practice and Health Services Research, University Hospital, Heidelberg, Germany.
Vasa. 2012 Sep;41(5):360-5. doi: 10.1024/0301-1526/a000222.
The role of varicose veins (VV) as a risk factor for development of deep venous thrombosis (DVT) is still controversial. The aim of this study in primary care was to determine the impact of varicosity as a potential risk factor for developing DVT.
During the observation period between 01-Jan-2008 and 01-Jan-2011, all cases with VV (ICD code I83.9) and DVT (ICD codes I80.1 - I80.9) were identified out of the CONTENT primary care register (Heidelberg, Germany). The exposure of VV and DVT was based solely on ICD coding without regarding the accuracy of the diagnosis. The covariates age, gender, surgery, hospitalization, congestive heart failure, malignancy, pregnancy, hormonal therapy, and respiratory infection were extracted for each patient. Multivariate binary logistic regression was performed in order to assess potential risk factors for DVT. The SAS procedure "PROC GENMOD" (SAS version 9.2, 64-bit) was parameterised accordingly. A potential cluster effect (patients within practices) was regarded in the regression model.
There were 132 out of 2,357 (5.6 %) DVT episodes among patients with VV compared to 728 out of 80,588 (0.9 %) in the patient cohort without VV (p < 0.0001). An increased risk of DVT was associated with previous DVT (adjusted odds ratio (OR): 9.07, 95 % confidence interval (CI): 7.78 - 10.91), VV (OR 7.33 [CI 6.14 - 8.74]), hospitalization during the last 6 months (OR 1.69 [CI 1.29 - 2.22]), malignancy (OR 1.55 [CI 1.19 - 2.02]), and age (OR 1.02 [CI 1.01 - 1.03]).
There are strong associations between VV and DVT in a general practice population with documented VV. Special medical attention is required for patients with VV, a history of previous venous thromboembolism, comorbid malignancy, and recent hospital discharge, particularly those with a combination of these factors.
静脉曲张（VV）作为深静脉血栓形成（DVT）的一个危险因素，其作用仍存在争议。本初级保健研究的目的是确定静脉曲张作为发生DVT的潜在危险因素所产生的影响。
在2008年1月1日至2011年1月1日的观察期内，从CONTENT初级保健登记册（德国海德堡）中识别出所有患有VV（国际疾病分类代码I83.9）和DVT（国际疾病分类代码I80.1 - I80.9）的病例。VV和DVT的暴露仅基于国际疾病分类编码，而不考虑诊断的准确性。为每位患者提取协变量年龄、性别、手术、住院、充血性心力衰竭、恶性肿瘤、妊娠、激素治疗和呼吸道感染。进行多变量二元逻辑回归以评估DVT的潜在危险因素。相应地对SAS程序“PROC GENMOD”（SAS版本9.2，64位）进行参数化。回归模型中考虑了潜在的聚类效应（医疗机构内的患者）。
患有VV的患者中，2357例中有132例（5.6%）发生DVT，而在无VV的患者队列中，80588例中有728例（0.9%）发生DVT（p < 0.0001）。DVT风险增加与既往DVT（调整后的优势比（OR）：9.07，95%置信区间（CI）：7.78 - 10.91）、VV（OR 7.33 [CI 6.14 - 8.74]）、过去6个月内住院（OR 1.69 [CI 1.29 - 2.22]）、恶性肿瘤（OR 1.55 [CI 1.19 - 2.02]）和年龄（OR 1.02 [CI 1.01 - 1.03]）相关。
在有记录的静脉曲张的普通实践人群中，VV与DVT之间存在密切关联。对于患有静脉曲张、既往有静脉血栓栓塞病史、合并恶性肿瘤以及近期出院的患者，尤其是那些合并这些因素的患者，需要特别的医疗关注。
