From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Circulation. 2014 Sep 2;130(10):829-36. doi: 10.1161/CIRCULATIONAHA.114.009107. Epub 2014 Jun 26.
Studies on long-term mortality after venous thromboembolism (VTE) are sparse.
Using Danish medical databases, we conducted a 30-year nationwide population-based cohort study of 128 223 patients with first-time VTE (1980-2011) and a comparison cohort of 640 760 people from the general population (without VTE) randomly matched by sex, year of birth, and calendar period. The mortality risks for patients with deep venous thrombosis (DVT) and pulmonary embolism (PE) were markedly higher than for the comparison cohort during the first year, especially within the first 30 days (3.0% and 31% versus 0.4%). Using Cox regression, we assessed mortality rate ratios (MRRs) with 95% confidence intervals (CIs). The overall 30-year MRR was 1.55 (95% CI, 1.53-1.57) for DVT and 2.77 (95% CI, 2.74-2.81) for PE. The 30-day MRR was 5.38 (95% CI, 5.00-5.80) for DVT and 80.87 (95% CI, 76.02-86.02) for PE. Over time, the 30-day MRR was consistently 5- to 6-fold increased for DVT, whereas it improved for PE from 138 (95% CI, 125-153) in 1980 to 1989 to 36.08 (95% CI, 32.65-39.87) in 2000 to 2011. The 1- to 10-year and 11- to 30-year MRRs remained 25% to 40% increased after both DVT and PE but were 3- to 5-fold increased after DVT and 6- to 11-fold increased after PE when VTE was considered the immediate cause of death.
Patients with VTE are at increased risk of dying, especially within the first year after diagnosis, but also during the entire 30 years of follow-up, with VTE as an important cause of death. Although 30-day mortality after DVT remained fairly constant over the last 3 decades, it improved markedly for PE.
静脉血栓栓塞症（VTE）后长期死亡率的研究较少。
我们使用丹麦医疗数据库，对 1980 年至 2011 年间首次发生 VTE（深静脉血栓形成[DVT]和肺栓塞[PE]）的 128223 例患者和通过性别、出生年份和日历期随机匹配的来自普通人群（无 VTE）的 640760 人进行了一项 30 年全国性基于人群的队列研究。与对照组相比，DVT 和 PE 患者在发病后的第一年，尤其是在发病后的前 30 天内（3.0%和 31% vs. 0.4%）死亡率明显升高。我们使用 Cox 回归评估了死亡率比值比（MRR）及其 95%置信区间（CI）。DVT 的 30 年总 MRR 为 1.55（95%CI，1.53-1.57），PE 为 2.77（95%CI，2.74-2.81）。DVT 的 30 天 MRR 为 5.38（95%CI，5.00-5.80），PE 为 80.87（95%CI，76.02-86.02）。随着时间的推移，DVT 的 30 天 MRR 持续增加了 5-6 倍，而 PE 则从 1980 年至 1989 年的 138（95%CI，125-153）增加到 2000 年至 2011 年的 36.08（95%CI，32.65-39.87）。DVT 和 PE 后 1-10 年和 11-30 年的 MRR 仍增加了 25%-40%，但 DVT 后增加了 3-5 倍，PE 后增加了 6-11 倍，当 VTE 被认为是直接死亡原因时。
VTE 患者的死亡风险增加，尤其是在诊断后的第一年，但在整个 30 年的随访中也是如此，VTE 是死亡的一个重要原因。尽管过去 30 年来 DVT 后 30 天的死亡率相对稳定，但 PE 的死亡率显著改善。
