Tang Liang, Wu Ying-Ying, Lip Gregory Y H, Yin Ping, Hu Yu
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Lancet Haematol. 2016 Jan;3(1):e30-44. doi: 10.1016/S2352-3026(15)00228-8. Epub 2015 Dec 4.
Venous thromboembolism is a major global health problem that is often secondary to other clinical situations. Many studies have investigated the association between venous thromboembolism and heart failure, but have yielded inconsistent findings. We aimed to quantify the absolute and relative risks (RR) for venous thromboembolism in patients with heart failure after hospital admission. We also assessed rates of venous thromboembolism in patients in different settings.
In this systematic review and meta-analysis, we searched for studies investigating the risk of venous thromboembolism in patients in hospital with heart failure. We searched for studies published between Jan 1, 1955, and March 31, 2015, in PubMed, Embase, Evidence-Based Medicine Reviews, Allied and Complementary Medicine Database, Ovid HealthSTAR, Global Health, Ovid Nursing Database, Web of Science, CINAHL Plus, ProQuest Central, Conference Papers Index, BIOSIS Previews, and ClinicalTrials.gov. All cohort studies and subgroup analyses of randomised controlled trials (RCTs) were eligible for inclusion if they reported venous thromboembolism rates (number of events per follow-up period) or RR estimates. We extracted data from published reports and contacted the corresponding authors of records with insufficient quantitative data. RRs and 95% CIs were pooled using a random-effects model. This study is registered with PROSPERO, number CRD42014015504.
Of 8673 records identified, we included 71 studies with data from 88 cohorts in our analysis, with 59 cohorts included in the assessment of venous thromboembolism rates and 46 cohorts included in the meta-analysis of heart failure and risk of venous thromboembolism. Venous thromboembolism rates varied widely in patients in hospital with heart failure from different settings. The overall median symptomatic venous thromboembolism rate was 2·48% (IQR 0·84-5·61); rates was were 3·73% (1·05-7·31) for patients who did not receive thromboprophylaxis and 1·47% (0·64-3·54) for those who did. Overall, patients with heart failure in hospital had an RR of 1·51 (1·36-1·68) for venous thromboembolism. The overall I(2) statistic was 96·1% and there was no evidence of publication bias (Egger's test, p=0·46).
Heart failure is a common independent risk factor for venous thromboembolism. Thromoboprophylaxis should be considered in clinical practice for high-risk patients.
National Natural Science Foundation.
静脉血栓栓塞是一个重大的全球健康问题，通常继发于其他临床情况。许多研究调查了静脉血栓栓塞与心力衰竭之间的关联，但结果并不一致。我们旨在量化心力衰竭患者入院后发生静脉血栓栓塞的绝对风险和相对风险（RR）。我们还评估了不同情况下患者的静脉血栓栓塞发生率。
在这项系统评价和荟萃分析中，我们检索了调查心力衰竭住院患者静脉血栓栓塞风险的研究。我们检索了1955年1月1日至2015年3月31日期间发表在PubMed、Embase、循证医学评论、综合与补充医学数据库、Ovid HealthSTAR、全球健康、Ovid护理数据库、科学网、CINAHL Plus、ProQuest Central、会议论文索引、BIOSIS Previews和ClinicalTrials.gov上的研究。所有队列研究和随机对照试验（RCT）的亚组分析，只要报告了静脉血栓栓塞发生率（每个随访期的事件数）或RR估计值，均符合纳入标准。我们从已发表的报告中提取数据，并与定量数据不足的记录的相应作者联系。使用随机效应模型汇总RR和95%CI。本研究已在PROSPERO注册，注册号为CRD42014015504。
在识别出的8673条记录中，我们纳入了71项研究，分析中有来自88个队列的数据，59个队列纳入了静脉血栓栓塞发生率评估，46个队列纳入了心力衰竭与静脉血栓栓塞风险的荟萃分析。不同情况下心力衰竭住院患者的静脉血栓栓塞发生率差异很大。总体症状性静脉血栓栓塞发生率中位数为2.48%（IQR 0.84 - 5.61）；未接受血栓预防的患者发生率为3.73%（1.05 - 7.31），接受预防的患者为1.47%（0.64 - 3.54）。总体而言，心力衰竭住院患者发生静脉血栓栓塞的RR为1.51（1.36 - 1.68）。总体I²统计量为96.1%，没有证据表明存在发表偏倚（Egger检验，p = 0.46）。
心力衰竭是静脉血栓栓塞的常见独立危险因素。在临床实践中，应考虑对高危患者进行血栓预防。
国家自然科学基金。
