INSERM, CIC1408, Saint-Etienne F-42055, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne F-42055, France; CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne F-42055, France; GIRC-Thrombose-INNOVTE network, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France.
INSERM, CIC1408, Saint-Etienne F-42055, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne F-42055, France; CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne F-42055, France; GIRC-Thrombose-INNOVTE network, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France.
Eur J Intern Med. 2016 May;30:72-76. doi: 10.1016/j.ejim.2016.02.022. Epub 2016 Mar 11.
Even despite the use of thromboprophylaxis, some patients with an acute medical illness develop symptomatic venous thromboembolism (VTE). It is unclear whether the outcome in these patients is different in those in whom prophylaxis was not prescribed.
We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) database to compare the 3-month outcome (death, fatal pulmonary embolism, VTE recurrences, major bleeding) of patients with acute VTE after immobilization for an acute medical disease, according to the use of prophylaxis.
Thromboprophylaxis was prescribed in 1313 (37%) of the 3527 patients included in August 2014. Acute infection was the most frequent cause of immobilization. Patients who received prophylaxis were more frequently immobilized in hospital than at home (70% vs. 22%), and fewer patients were immobilized for cancer (13% vs. 22%). During the first 3months of treatment, the rates of all-cause death (23 vs. 21%), fatal PE (2.6 vs. 3.1%), VTE recurrences (2.4% vs. 2.8%), and major bleeding (4.2% for both) did not differ between the two groups. Thromboprophylaxis was not associated with each outcome in multivariate analysis.
The outcome in patients with VTE provoked by medical immobilization was not influenced by the use of thromboprophylaxis during the period of immobility.
即使使用了血栓预防措施，一些患有急性内科疾病的患者仍会出现有症状的静脉血栓栓塞症（VTE）。目前尚不清楚在未开具预防措施的情况下，这些患者的预后是否不同。
我们使用 RIETE（血栓栓塞登记信息系统）数据库，根据预防措施的使用情况，比较了 2014 年 8 月纳入的 3527 例因急性内科疾病而制动的急性 VTE 患者的 3 个月结局（死亡、致死性肺栓塞、VTE 复发、大出血）。
在纳入的 3527 例患者中，有 1313 例（37%）接受了血栓预防措施。急性感染是导致制动的最常见原因。接受预防措施的患者更常被安置在医院而不是家中（70% vs. 22%），且较少的患者因癌症而制动（13% vs. 22%）。在治疗的前 3 个月，两组患者的全因死亡率（23% vs. 21%）、致死性 PE（2.6% vs. 3.1%）、VTE 复发（2.4% vs. 2.8%）和大出血（均为 4.2%）发生率均无差异。多变量分析显示，血栓预防措施与每种结局均无关。
在因医学制动而引发 VTE 的患者中，在制动期间使用血栓预防措施与结局无关。
