K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
K. G. Jebsen - Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
J Am Heart Assoc. 2016 Nov 7;5(11):e004311. doi: 10.1161/JAHA.116.004311.
Even though clinical data support a relation between ischemic stroke and venous thromboembolism (VTE), the strength and time dependence of the association remain to be settled at the population level. We therefore aimed to investigate the association between ischemic stroke and VTE in a prospective population-based cohort.
Participants (n=30 002) were recruited from 3 surveys of the Tromsø study (conducted in 1994-1995, 2001, and 2007-2008) and followed through 2010. All incident events of ischemic stroke and VTE during follow-up were recorded. Cox-regression models with age as time scale and ischemic stroke as a time-dependent variable were used to calculate hazard ratios (HR) of VTE adjusted for cardiovascular risk factors. During a median follow-up time of 15.7 years, 1360 participants developed ischemic stroke and 722 had a VTE. The risk of VTE was highest the first month (HR 19.7; 95% CI, 10.1-38.5) and from 1 to 3 months after the stroke (HR 10.6; 95% CI 5.0-22.5), but declined rapidly thereafter. The risk estimates were approximately the same for deep vein thrombosis (HR 19.1; 95% CI, 7.8-38.5), and pulmonary embolism (HR 20.2; 95% CI, 7.4-55.1). Stroke was associated with higher risk for provoked (HR 22.6; 95% CI, 12.5-40.9) than unprovoked VTE (HR 7.4; 95% CI, 2.7-20.1) the first 3 months.
The risk of VTE increased during the first 3 months after an ischemic stroke. The particularly high risk of provoked VTE suggests that additional predisposing factors, such as immobilization, potentiate the VTE risk in patients with ischemic stroke.
尽管临床数据支持缺血性中风与静脉血栓栓塞症（VTE）之间存在关联，但在人群层面上，这种关联的强度和时间依赖性仍有待确定。因此，我们旨在前瞻性人群队列中研究缺血性中风与 VTE 之间的关联。
参与者（n=30002）来自特罗姆瑟研究的 3 项调查（分别于 1994-1995 年、2001 年和 2007-2008 年进行），并随访至 2010 年。在随访期间记录所有缺血性中风和 VTE 的事件。使用 Cox 回归模型，以年龄为时间尺度，将缺血性中风作为时间依赖性变量，计算调整心血管危险因素后的 VTE 风险比（HR）。在中位数为 15.7 年的随访期间，1360 名参与者发生缺血性中风，722 名参与者发生 VTE。VTE 的风险在发病后的第一个月最高（HR 19.7；95%CI，10.1-38.5），发病后 1-3 个月次之（HR 10.6；95%CI，5.0-22.5），但此后迅速下降。深静脉血栓形成（HR 19.1；95%CI，7.8-38.5）和肺栓塞（HR 20.2；95%CI，7.4-55.1）的风险估计值大致相同。在发病后的前 3 个月，与非诱因性 VTE（HR 7.4；95%CI，2.7-20.1）相比，诱因性 VTE（HR 22.6；95%CI，12.5-40.9）的风险更高。
缺血性中风后 3 个月内 VTE 的风险增加。诱因性 VTE 的风险特别高，表明在缺血性中风患者中，附加的易患因素（如制动）会增加 VTE 的风险。
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