Dept of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands.
Dept of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
Eur Respir Rev. 2018 Nov 28;27(150). doi: 10.1183/16000617.0094-2018. Print 2018 Dec 31.
Current guidelines recommend long-term anticoagulant therapy in patients with unprovoked venous thromboembolism (VTE). The risk of fatal recurrent VTE after treatment discontinuation ( that of fatal bleeding during anticoagulation) is of particular relevance in the decision to continue or stop anticoagulation after the first 3 months. Our primary aim was to provide a point-estimate of the yearly rate of fatal recurrent VTE and VTE case-fatality rate in patients with unprovoked VTE after anticoagulation cessation. Data were extracted from both randomised controlled trials and observational studies published before May 1, 2017. The pooled fatality rates were calculated using a random-effects model. 18 studies with low-to-moderate bias were included in the primary analysis, totalling 6758 patients with a median (range) follow-up duration of 2.2 (1-5) years. After anticoagulation cessation, the weighted pooled rate of VTE recurrence was 6.3 (95% CI 5.4-7.3) per 100 patient-years and the weighted pooled rate of fatal recurrent VTE was 0.17 (95% CI 0.047-0.33) per 100 patient-years, for a case-fatality rate of 2.6% (95% CI 0.86-5.0). These numbers are a solid benchmark for comparison to the risks associated with long-term anticoagulation treatment for the decision on the optimal duration of treatment of patients with unprovoked VTE.
目前的指南建议对无诱因静脉血栓栓塞症（VTE）患者进行长期抗凝治疗。停止抗凝治疗后（抗凝期间出血）致命性复发性 VTE 的风险在决定是否继续或停止抗凝治疗方面特别重要，特别是在首次 3 个月后。我们的主要目的是提供一个无诱因 VTE 患者停止抗凝治疗后致命性复发性 VTE 和 VTE 病死率的年度发生率的点估计值。数据来自于 2017 年 5 月 1 日之前发表的随机对照试验和观察性研究。使用随机效应模型计算合并病死率。初级分析中纳入了 18 项低至中度偏倚的研究，共纳入了 6758 例患者，中位（范围）随访时间为 2.2（1-5）年。停止抗凝治疗后，VTE 复发的加权合并发生率为每 100 患者-年 6.3（95%CI 5.4-7.3），致命性复发性 VTE 的加权合并发生率为每 100 患者-年 0.17（95%CI 0.047-0.33），病死率为 2.6%（95%CI 0.86-5.0）。这些数字为比较无诱因 VTE 患者治疗最佳持续时间的长期抗凝治疗相关风险提供了一个可靠的基准。
