Asim Mohammad, Al-Thani Hassan, El-Menyar Ayman
Department of Surgery, Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
Department of Vascular Surgery, Hamad General Hospital, Doha, Qatar.
Med Sci Monit. 2017 May 20;23:2391-2399. doi: 10.12659/msm.901924.
BACKGROUND We investigated the frequency, clinical presentation, risk factors, and outcome after the first deep vein thrombosis (DVT) event. MATERIAL AND METHODS A retrospective study was conducted for patients with DVT between 2008 and 2012 with a 1-year follow-up. Patients were divided into 2 groups: single vs. recurrent DVT (RDVT). RESULTS Of the 6420 patients screened for DVT, 662 (10.3%) had DVT. RDVT constituted 22% of cases. A single event was more frequent in left lower limb DVT (p=0.01), while RDVT cases had more bilateral DVT (p=0.01). Recurrent pulmonary embolism (PE) and comorbidities were significantly higher in the RDVT group (P<0.05). Protein C, protein S, and anti-thrombin III deficiency were higher in patients with RDVT (P<0.05). Post-thrombotic syndrome was significantly higher among RDVT cases (p=0.01). In addition, obesity, abnormal coagulation, and prior history of PE and bilateral DVT were found to be independent predictors of RDVT. The PE rate was greater with RDVT than those with single events (22% vs. 9%, p=0.001); however, during follow-up and after adjustment for age and sex, this effect was statistically insignificant (adjusted HR 1.23, 95% CI 0.43-3.57, p=0.68). The age- and sex-adjusted mortality rate was higher in patients with single events with a HR 2.3; 95%CI 1.18-4.54 (p=0.01); however, this effect disappeared after adjusting for the duration of warfarin therapy (p=0.22). CONCLUSIONS Patients with RDVT are common and have characteristic features that required more attention and further evaluation. These findings should help identifying high-risk patients and set effective preventive measures for RDVT that may revise the duration of warfarin therapy.
背景 我们调查了首次发生深静脉血栓形成（DVT）事件后的发生率、临床表现、危险因素及预后情况。
材料与方法 对2008年至2012年期间发生DVT且随访1年的患者进行回顾性研究。将患者分为两组：单发DVT与复发DVT（RDVT）。
结果 在筛查的6420例DVT患者中，662例（10.3%）发生DVT。RDVT占病例的22%。单发事件在左下肢DVT中更为常见（p=0.01），而RDVT病例双侧DVT更多（p=0.01）。RDVT组复发性肺栓塞（PE）和合并症显著更高（P<0.05）。RDVT患者蛋白C、蛋白S和抗凝血酶III缺乏更高（P<0.05）。RDVT病例中血栓形成后综合征显著更高（p=0.01）。此外，肥胖、凝血异常以及既往PE和双侧DVT病史被发现是RDVT的独立预测因素。RDVT的PE发生率高于单发事件者（22%对9%，p=0.001）；然而，在随访期间并对年龄和性别进行调整后，这种效应在统计学上无显著意义（调整后HR 1.23，95%CI 0.43 - 3.57，p=0.68）。单发事件患者经年龄和性别调整后的死亡率更高，HR为2.3；95%CI 1.18 - 4.54（p=0.01）；然而，在对华法林治疗持续时间进行调整后，这种效应消失（p=0.22）。
结论 RDVT患者很常见，具有需要更多关注和进一步评估的特征。这些发现应有助于识别高危患者，并为RDVT制定有效的预防措施，这可能会调整华法林治疗的持续时间。
