Palazzo Paola, Agius Pierre, Ingrand Pierre, Ciron Jonathan, Lamy Matthias, Berthomet Aline, Cantagrel Paul, Neau Jean-Philippe
From the Department of Neurology, Poitiers University Hospital and University of Poitiers, France (P.P., P.A., J.C., M.L., A.B., P.C., J.-P.N.); Department of Neurology, S. Giovanni Calibita-Fatebenefratelli Hospital, Rome, Italy (P.P.); and Clinical Investigation Center INSERM CIC-P 802, Poitiers University Hospital, France (P.I.).
Stroke. 2017 Feb;48(2):321-326. doi: 10.1161/STROKEAHA.116.015294. Epub 2016 Dec 15.
After cerebral venous thrombosis (CVT), the risk of venous thrombotic events was estimated at 2% to 3% for a new CVT and 3% to 8% for extracranial events. However, because of the paucity of prospective studies, the clinical course of CVT is still largely unknown. We aimed to prospectively evaluate the rate of thrombosis recurrence in a cohort of CVT patients with a long-term follow-up and to detect predisposing factors for recurrence.
Consecutive CVT patients with complete clinical, radiological, biological, and genetic data were systematically followed up. New venous thrombotic events were detected after hospital readmission and imaging confirmation.
One-hundred eighty-seven patients (mean age 45±18 years, 67% women) with angiographically confirmed CVT were included. Cause was found in 73% of patients. Coagulation abnormality and JAK2 gene mutation were detected in 20% and 9%, respectively. Median follow-up length was 73 months (range 1-247 months). Mean duration of the oral anticoagulant treatment was 14 months. Mortality rate was 2.5% per year, with 2% in-hospital mortality. During follow-up, CVT reoccurred in 6 patients, whereas 19 subjects had a symptomatic extracranial venous thrombotic event, with cumulative venous thrombotic recurrence rates of 3% at 1 year, 8% at 2 years, 12% at 5 years, and 18% at 10 years. A previous venous thrombotic event (hazard ratio, 2.8; P=0.018), presence of cancer or malignant hemopathies (hazard ratio, 3.2; P=0.039), and unknown CVT causes (hazard ratio, 2.81; P=0.024) were independently associated with recurrence.
In our cohort of CVT patients followed on average for >6 years, subjects with a previous venous thrombotic event, cancer/malignant hemopathies, and unknown CVT causes were found to be at higher risk of recurrence.
脑静脉血栓形成（CVT）后，新发CVT的静脉血栓形成事件风险估计为2%至3%，颅外事件的风险为3%至8%。然而，由于前瞻性研究较少，CVT的临床病程仍很大程度上未知。我们旨在对一组CVT患者进行长期随访，前瞻性评估血栓复发率，并检测复发的易感因素。
对具有完整临床、影像学、生物学和基因数据的连续CVT患者进行系统随访。在再次入院并经影像学确认后检测新发静脉血栓形成事件。
纳入187例经血管造影证实为CVT的患者（平均年龄45±18岁，67%为女性）。73%的患者找到了病因。分别在20%和9%的患者中检测到凝血异常和JAK2基因突变。中位随访时间为73个月（范围1 - 247个月）。口服抗凝治疗的平均持续时间为14个月。年死亡率为2.5%，住院死亡率为2%。随访期间，6例患者发生CVT复发，19例患者出现有症状的颅外静脉血栓形成事件，1年时静脉血栓形成累积复发率为3%，2年时为8%，5年时为12%，10年时为18%。既往静脉血栓形成事件（风险比，2.8；P = 0.018）、癌症或恶性血液病的存在（风险比，3.2；P = 0.039）以及不明CVT病因（风险比，2.81；P = 0.024）与复发独立相关。
在我们平均随访超过6年的CVT患者队列中，既往有静脉血栓形成事件、癌症/恶性血液病以及不明CVT病因的患者复发风险较高。
