Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA.
University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA.
J Thromb Haemost. 2015 Jun;13(6):1043-52. doi: 10.1111/jth.12914. Epub 2015 May 11.
Observational studies suggest index clinical manifestation of venous thromboembolism (VTE) predicts recurrence type. Data regarding the association between index manifestation and recurrence rates are conflicting.
To perform a meta-analysis of randomized controlled trials (RCTs) to determine the type and frequency of recurrent VTE (rVTE) in persons after an index deep vein thrombosis (DVT) or pulmonary embolism (PE).
PATIENTS/METHODS: We searched bibliographic databases for RCTs of acute (early) treatment of rVTE in persons with an index DVT or PE (±DVT), enrolling ≥ 50 subjects anticoagulated ≥ 3-months and reporting types of rVTE. We pooled (random-effects) the proportion of rVTEs that were DVTs, PEs, and fatal PEs, the proportion of recurrent PEs that were fatal, and absolute rVTE rates.
In nine RCTs (N = 13 640; 413 rVTEs) evaluating persons with an index PE; 66% (95% CI, 60-72%) of rVTEs were PE and 27% (95% CI, 22-33%) were fatal PE. Among 25 RCTs (N = 17 340; 692 rVTEs) evaluating persons with an index DVT, 36% (95% CI, 29-44%) experienced a recurrent PE and 10% (95% CI, 7-13%) a fatal PE. Recurrent PEs following an index PE had a higher fatality rate than after an index DVT (41%; 95% CI, 33-48% vs. 25%; 95% CI, 18-33%; P = 0.007). The rVTE rate was higher following an index DVT compared with a PE (2.6%; 95% CI, 1.6-3.8% vs. 4.9%; 95% CI, 4.0-6.0%; P = 0.002).
Our meta-analysis suggests most rVTEs will be the same type as the index event. While index DVTs are associated with a higher rVTE rate than index PEs; recurrent PEs are associated with high fatality.
观察性研究表明，静脉血栓栓塞症（VTE）的首发临床表现可预测复发类型。关于首发表现与复发率之间关系的数据存在争议。
对随机对照试验（RCT）进行荟萃分析，以确定首发深静脉血栓形成（DVT）或肺栓塞（PE）后患者的复发性 VTE（rVTE）的类型和频率。
患者/方法：我们检索了文献数据库，以寻找针对首发 DVT 或 PE（±DVT）的急性（早期）rVTE 治疗的 RCT，纳入了至少 50 名接受抗凝治疗≥3 个月且报告了 rVTE 类型的患者。我们对 DVT、PE 和致命性 PE 的 rVTE 比例、复发性 PE 中的致命性比例以及绝对 rVTE 率进行了（随机效应）汇总。
在 9 项 RCT 中（N = 13640；413 例 rVTE）评估首发 PE 的患者中，66%（95%CI，60-72%）的 rVTE 为 PE，27%（95%CI，22-33%）为致命性 PE。在 25 项 RCT 中（N = 17340；692 例 rVTE）评估首发 DVT 的患者中，36%（95%CI，29-44%）发生了复发性 PE，10%（95%CI，7-13%）发生了致命性 PE。首发 PE 后的复发性 PE 死亡率高于首发 DVT（41%；95%CI，33-48% vs. 25%；95%CI，18-33%；P = 0.007）。与首发 PE 相比，首发 DVT 后 rVTE 发生率更高（2.6%；95%CI，1.6-3.8% vs. 4.9%；95%CI，4.0-6.0%；P = 0.002）。
我们的荟萃分析表明，大多数 rVTE 将与首发事件的类型相同。虽然首发 DVT 与较高的 rVTE 发生率相关，但首发 PE 与高死亡率相关。
