Prof. Manuel Monreal, MD, PhD, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain, Tel.: +34 669675313, E-mail:
Thromb Haemost. 2013 Nov;110(5):1025-34. doi: 10.1160/TH13-04-0352. Epub 2013 Aug 8.
The relationship between platelet count and outcome in patients with acute venous thromboembolism (VTE) has not been consistently explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We categorised patients as having very low- (<80,000/µl), low- (80,000/µl to 150,000/µl), normal- (150,000/µl to 300,000/µl), high- (300,000/µl to 450,000/µl), or very high (>450,000/µl) platelet count at baseline, and compared their three-month outcome. As of October 2012, 43,078 patients had been enrolled in RIETE: 21,319 presenting with pulmonary embolism and 21,759 with deep-vein thrombosis. In all, 502 patients (1.2%) had very low-; 5,472 (13%) low-; 28,386 (66%) normal-; 7,157 (17%) high-; and 1,561 (3.6%) very high platelet count. During the three-month study period, the recurrence rate was: 2.8%, 2.2%, 1.8%, 2.1% and 2.2%, respectively; the rate of major bleeding: 5.8%, 2.6%, 1.7%, 2.3% and 4.6%, respectively; the rate of fatal bleeding: 2.0%, 0.9%, 0.3%, 0.5% and 1.2%, respectively; and the mortality rate: 29%, 11%, 6.5%, 8.8% and 14%, respectively. On multivariate analysis, patients with very low-, low-, high- or very high platelet count had an increased risk for major bleeding (odds ratio [OR]: 2.70, 95% confidence interval [CI]: 1.85-3.95; 1.43 [1.18-1.72]; 1.23 [1.03-1.47]; and 2.13 [1.65-2.75]) and fatal bleeding (OR: 3.70 [1.92-7.16], 2.10 [1.48-2.97], 1.29 [0.88-1.90] and 2.49 [1.49-4.15]) compared with those with normal count. In conclusion, we found a U-shaped relationship between platelet count and the three-month rate of major bleeding and fatal bleeding in patients with VTE.
血小板计数与急性静脉血栓栓塞症（VTE）患者预后之间的关系尚未得到一致探讨。RIETE 是一项正在进行的连续 VTE 患者登记研究。我们将患者基线时的血小板计数分为极低（＜80,000/µl）、低（80,000/µl 至 150,000/µl）、正常（150,000/µl 至 300,000/µl）、高（300,000/µl 至 450,000/µl）或极高（＞450,000/µl），并比较了他们的三个月预后。截至 2012 年 10 月，43,078 名患者已被纳入 RIETE：21,319 名患者出现肺栓塞，21,759 名患者出现深静脉血栓形成。共有 502 名患者（1.2%）血小板计数极低；5,472 名患者（13%）血小板计数较低；28,386 名患者（66%）血小板计数正常；7,157 名患者（17%）血小板计数较高；1,561 名患者（3.6%）血小板计数极高。在三个月的研究期间，复发率分别为：2.8%、2.2%、1.8%、2.1%和 2.2%；大出血发生率分别为：5.8%、2.6%、1.7%、2.3%和 4.6%；致命性出血发生率分别为：2.0%、0.9%、0.3%、0.5%和 1.2%；死亡率分别为：29%、11%、6.5%、8.8%和 14%。多变量分析显示，血小板计数极低、低、高或极高的患者发生大出血的风险增加（比值比[OR]：2.70，95%置信区间[CI]：1.85-3.95；1.43 [1.18-1.72]；1.23 [1.03-1.47]；和 2.13 [1.65-2.75]）和致命性出血（OR：3.70 [1.92-7.16]、2.10 [1.48-2.97]、1.29 [0.88-1.90]和 2.49 [1.49-4.15]）与计数正常的患者相比。总之，我们发现 VTE 患者血小板计数与三个月大出血和致命性出血发生率之间呈 U 型关系。
