脑静脉血栓形成后发生肺栓塞的风险
Risk of Pulmonary Embolism After Cerebral Venous Thrombosis.
作者信息
Liberman Ava L, Merkler Alexander E, Gialdini Gino, Messé Steven R, Lerario Michael P, Murthy Santosh B, Kamel Hooman, Navi Babak B
机构信息
From the Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (A.E.M., G.G., S.B.M., H.K., B.B.N.), and Department of Neurology, Weill Cornell Medicine (A.E.M., G.G., S.B.M., H.K., B.B.N.), New York, NY; Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); and Department of Neurology, Weill Cornell Medicine, New York-Presbyterian Queens, Flushing, NY (M.P.L.).
出版信息
Stroke. 2017 Mar;48(3):563-567. doi: 10.1161/STROKEAHA.116.016316. Epub 2017 Feb 22.
BACKGROUND AND PURPOSE
Cerebral vein thrombosis (CVT) is a type of venous thromboembolism. Whether the risk of pulmonary embolism (PE) after CVT is similar to the risk after deep venous thrombosis (DVT) is unknown.
METHODS
We performed a retrospective cohort study using administrative data from all emergency department visits and hospitalizations in California, New York, and Florida from 2005 to 2013. We identified patients with CVT or DVT and the outcome of PE using previously validated codes. Kaplan-Meier survival statistics and Cox proportional hazards models were used to compare the risk of PE after CVT versus PE after DVT.
RESULTS
We identified 4754 patients with CVT and 241 276 with DVT. During a mean follow-up of 3.4 (±2.4) years, 138 patients with CVT and 23 063 with DVT developed PE. CVT patients were younger, more often female, and had fewer risk factors for thromboembolism than patients with DVT. During the index hospitalization, the rate of PE was 1.4% (95% confidence interval [CI], 1.1%-1.8%) in patients with CVT and 6.6% (95% CI, 6.5%-6.7%) in patients with DVT. By 5 years, the cumulative rate of PE after CVT was 3.4% (95% CI, 2.9%-4.0%) compared with 10.9% (95% CI, 10.8%-11.0%; <0.001) after DVT. CVT was associated with a lower adjusted hazard of PE than DVT (hazard ratio, 0.26; 95% CI, 0.22-0.31).
CONCLUSION
The risk of PE after CVT was significantly lower than the risk after DVT. Among patients with CVT, the greatest risk for PE was during the index hospitalization.
背景与目的
脑静脉血栓形成（CVT）是静脉血栓栓塞的一种类型。CVT后发生肺栓塞（PE）的风险是否与深静脉血栓形成（DVT）后相似尚不清楚。
方法
我们利用2005年至2013年加利福尼亚州、纽约州和佛罗里达州所有急诊科就诊和住院的管理数据进行了一项回顾性队列研究。我们使用先前验证的编码识别出患有CVT或DVT的患者以及PE结局。采用Kaplan-Meier生存统计和Cox比例风险模型比较CVT后与DVT后发生PE的风险。
结果
我们识别出4754例CVT患者和241276例DVT患者。在平均3.4（±2.4）年的随访期间，138例CVT患者和23063例DVT患者发生了PE。CVT患者比DVT患者更年轻，女性更多，血栓栓塞风险因素更少。在首次住院期间，CVT患者的PE发生率为1.4%（95%置信区间[CI]，1.1%-1.8%），DVT患者为6.6%（95%CI，6.5%-6.7%）。到5年时，CVT后PE的累积发生率为3.4%（95%CI，2.9%-4.0%），而DVT后为10.9%（95%CI，10.8%-11.0%；P<0.001）。与DVT相比，CVT与调整后较低的PE风险相关（风险比，0.26；95%CI，0.22-0.31）。
结论
CVT后发生PE的风险显著低于DVT后。在CVT患者中，PE的最大风险发生在首次住院期间。
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