三级医疗机构中诱发性深静脉血栓的特征。
Characteristics of provoked deep venous thrombosis in a tertiary care center.
机构信息
Department of Surgery, Yale School of Medicine, New Haven, Conn.
Yale School of Medicine, New Haven, Conn.
出版信息
J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):477-484. doi: 10.1016/j.jvsv.2017.02.006. Epub 2017 May 9.
OBJECTIVE
Provoked deep venous thrombosis (DVT) is precipitated by a specific event. This paper compares the characteristics of provoked DVT in patients with transient risk (TR) factors and patients with continuous risk (CR) factors.
METHODS
A retrospective review of records of all consecutive patients diagnosed with DVT between January 2013 and August 2014 was performed. Patients with provoked DVT were included in the TR group if the provoking event resolved in 2 weeks and they did not have ongoing risk of thrombosis. Patients in the CR group had a provoked DVT with ongoing risk of thrombosis due to individual factors deemed to be ongoing risks of thrombosis, such as cancer, hypercoagulable disorder, and prolonged immobilization. Demographics, risk factors, association with pulmonary embolism (PE) and its severity, risk of recurrent venous thromboembolism (VTE), and mortality were compared between the two groups.
RESULTS
A total of 838 patients were diagnosed with DVT, and 50.7% (425) were provoked. There were 127 (29.9%) patients with TR and 298 (70.1%) with CR. TR patients were younger (60.4 ± 16.3 vs 65.9 ± 16.0; P = .001). TR was more likely to be provoked by surgery (70.9% vs 55.4%; P = .003), whereas CR was more likely to be provoked by immobilization (21.5% vs 12.6%; P = .032). CR patients were affected by cancer (48.7%) and hypercoagulable disorders (4.4%). TR patients were more likely to have calf DVTs (36.2% vs 26.2%; P = .047). There was a trend toward lower association with PE on presentation in TR (17.3% vs 21.1%; P = .072), but that did not reach statistical significance. However, TR factors were more likely to be associated with low-risk PE compared with CR factors (30.2% vs 54.6%; P = .040). After mean follow-up of 7.2 months, CR had higher risk of recurrent VTE (14.0% vs 6.8%; P = .045) and mortality (23.5% vs 7.1%; P < .0001).
CONCLUSIONS
Provoked DVT with CR factors affects older patients and is associated with high recurrence of VTE and mortality compared with provoked DVT with TR factors.
目的
诱发性深静脉血栓形成（DVT）是由特定事件引发的。本文比较了具有短暂风险（TR）因素和持续风险（CR）因素的诱发性 DVT 患者的特征。
方法
回顾性分析 2013 年 1 月至 2014 年 8 月期间连续诊断为 DVT 的所有患者的病历。如果诱发事件在 2 周内解决且不存在持续血栓形成风险，则将具有诱发性 DVT 的患者纳入 TR 组。CR 组的患者存在持续的血栓形成风险，因为个体因素被认为是持续的血栓形成风险，例如癌症、高凝状态和长时间固定。比较两组之间的人口统计学特征、危险因素、与肺栓塞（PE）及其严重程度的关系、复发性静脉血栓栓塞症（VTE）风险和死亡率。
结果
共诊断出 838 例 DVT 患者，其中 50.7%（425 例）为诱发性。TR 组有 127 例（29.9%），CR 组有 298 例（70.1%）。TR 患者更年轻（60.4±16.3 岁 vs. 65.9±16.0 岁；P=0.001）。TR 更可能由手术引起（70.9% vs. 55.4%；P=0.003），而 CR 更可能由固定引起（21.5% vs. 12.6%；P=0.032）。CR 患者患有癌症（48.7%）和高凝状态（4.4%）。TR 患者更可能患有小腿 DVT（36.2% vs. 26.2%；P=0.047）。TR 患者在就诊时与 PE 的相关性呈下降趋势（17.3% vs. 21.1%；P=0.072），但未达到统计学意义。然而，与 CR 因素相比，TR 因素更可能与低危 PE 相关（30.2% vs. 54.6%；P=0.040）。在平均 7.2 个月的随访后，CR 患者的 VTE 复发风险（14.0% vs. 6.8%；P=0.045）和死亡率（23.5% vs. 7.1%；P<0.0001）更高。
结论
与具有 TR 因素的诱发性 DVT 相比，具有 CR 因素的诱发性 DVT 影响年龄较大的患者，且与 VTE 复发和死亡率高有关。
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