Wang Chun-Cheng, Lin Cheng-Li, Wang Guei-Jane, Chang Chiz-Tzung, Sung Fung-Chang, Kao Chia-Hung
Prof. Chia-Hung Kao, MD, Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan, Tel.: +886 4 22052121×7412, Fax: +886 4 22336174, E-mail:
Thromb Haemost. 2015 Jan;113(1):185-92. doi: 10.1160/TH14-05-0405. Epub 2014 Oct 16.
Whether atrial fibrillation (AF) is associated with an increased risk of venous thromboembolism (VTE) remains controversial. From Longitudinal Health Insurance Database 2000 (LHID2000), we identified 11,458 patients newly diagnosed with AF. The comparison group comprised 45,637 patients without AF. Both cohorts were followed up to measure the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Univariable and multivariable competing-risks regression model and Kaplan-Meier analyses with the use of Aelon-Johansen estimator were used to measure the differences of cumulative incidences of DVT and PE, respectively. The overall incidence rates (per 1,000 person-years) of DVT and PE between the AF group and non-AF groups were 2.69 vs 1.12 (crude hazard ratio [HR]= 1.92; 95 % confidence interval [CI] = 1.54-2.39), 1.55 vs 0.46 (crude HR = 2.68; 95 % CI = 1.97-3.64), respectively. The baseline demographics indicated that the members of the AF group demonstrated a significantly older age and higher proportions of comorbidities than non-AF group. After adjusting for age, sex, and comorbidities, the risks of DVT and PE remained significantly elevated in the AF group compared with the non-AF group (adjusted HR = 1.74; 95 %CI = 1.36-2.24, adjusted HR = 2.18; 95 %CI = 1.51-3.15, respectively). The Kaplan-Meier curve with the use of Aelon-Johansen estimator indicated that the cumulative incidences of DVT and PE were both more significantly elevated in the AF group than in the non-AF group after a long-term follow-up period (p<0.01). In conclusion, the presence of AF is associated with increased risk of VTE after a long-term follow-up period.
心房颤动（AF）是否与静脉血栓栓塞（VTE）风险增加相关仍存在争议。我们从2000年纵向健康保险数据库（LHID2000）中识别出11458例新诊断为AF的患者。对照组包括45637例无AF的患者。对两个队列进行随访以测量深静脉血栓形成（DVT）和肺栓塞（PE）的发生率。分别使用单变量和多变量竞争风险回归模型以及采用Aelon-Johansen估计量的Kaplan-Meier分析来测量DVT和PE累积发生率的差异。AF组与非AF组之间DVT和PE的总体发生率（每1000人年）分别为2.69对1.12（粗风险比[HR]=1.92；95%置信区间[CI]=1.54-2.39），1.55对0.46（粗HR=2.68；95%CI=1.97-3.64）。基线人口统计学表明，AF组成员的年龄显著大于非AF组，且合并症比例更高。在调整年龄、性别和合并症后AF组中DVT和PE的风险与非AF组相比仍显著升高（调整后HR=1.74；95%CI=1.36-2.24，调整后HR=2.18；95%CI=1.51-3.15）。采用Aelon-Johansen估计量的Kaplan-Meier曲线表明，经过长期随访期后，AF组中DVT和PE的累积发生率均比非AF组显著升高（p<0.01）。总之，长期随访后AF的存在与VTE风险增加相关。
