Pedrajas J M, Garmendia C, Portillo J, Gabriel F, Mainez C, Yera C, Monreal M
Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, España.
Servicio de Medicina Interna, Fundación Hospital Alcorcón, Alcorcón, Madrid, España.
Rev Clin Esp (Barc). 2014 Oct;214(7):357-64. doi: 10.1016/j.rce.2014.05.017. Epub 2014 Jun 21.
The Computerized Registry of Patients with Venous Thromboembolism (RIETE) is a prospective registry that consecutively includes patients diagnosed with venous thromboembolism. We compared the clinical presentation and response to anticoagulant treatment in patients with idiopathic venous thromboembolism (IVT) versus secondary venous thromboembolism (SVT, associated with a risk factor).
We analyzed the differences in clinical characteristics, comorbidity, treatment and events during the first 3months after the diagnosis of venous thromboembolism in patients with IVT or SVT and according to their initial clinical presentation.
A total of 39,921 patients with IVT (n=18,029; 45.1%) or SVT (n=21,892; 54.9%) were enrolled. The patients with IVT had a greater history of venous thromboembolism than those diagnosed with SVT (p<.001). The initial treatment was similar for the 2 groups, but more inferior vena cava filters were placed in the SVT group (p<.001). In the long term, low-molecular-weight heparin was used more often in the SVT group than in the IVT group. At 90days, bleeding, death and the recurrence of venous thromboembolism were significantly more frequent in the SVT group. The multivariate analysis confirmed that IVT was associated with fewer major (OR, 0.60; 95%CI, 0.50-0.61; p<.001) and fatal (OR, 0.41; 95%CI, 0.29-0.62; p<.001) bleedings, fewer relapses (OR, 0.58; 95%CI, 0.39-0.78; p<.001) and fewer fatal pulmonary embolisms (OR, 0.29; 95%CI, 0.12-0.52; p<.001). These differences were maintained in patients whose venous thromboembolism started with a pulmonary embolism or with deep vein thrombosis.
IVT has a better prognosis than SVT at 90days of the diagnosis.
静脉血栓栓塞症患者计算机注册系统（RIETE）是一个前瞻性注册系统，连续纳入诊断为静脉血栓栓塞症的患者。我们比较了特发性静脉血栓栓塞症（IVT）与继发性静脉血栓栓塞症（SVT，与危险因素相关）患者的临床表现及对抗凝治疗的反应。
我们分析了IVT或SVT患者在诊断静脉血栓栓塞症后前3个月内的临床特征、合并症、治疗及事件差异，并根据其初始临床表现进行分析。
共纳入39921例IVT患者（n = 18029；45.1%）或SVT患者（n = 21892；54.9%）。IVT患者的静脉血栓栓塞症病史比诊断为SVT的患者更常见（p <.001）。两组的初始治疗相似，但SVT组置入下腔静脉滤器更多（p <.001）。长期来看，SVT组比IVT组更常使用低分子肝素。在90天时，SVT组出血、死亡及静脉血栓栓塞症复发明显更常见。多变量分析证实，IVT与较少的严重（OR = 0.60；95%CI：0.50 - 0.61；p <.001）和致命（OR = 0.41；95%CI：0.29 - 0.62；p <.001）出血、较少的复发（OR = 0.58；95%CI：0.39 - 0.78；p <.001）和较少的致命性肺栓塞（OR = 0.29；95%CI：0.12 - 0.52；p <.001）相关。这些差异在以肺栓塞或深静脉血栓形成起始的静脉血栓栓塞症患者中也持续存在。
诊断90天时，IVT的预后优于SVT。
