Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
J Thromb Thrombolysis. 2019 Apr;47(3):444-453. doi: 10.1007/s11239-018-1791-2.
The influence of anemia on the long-term clinical outcomes has not been fully evaluated in patients with venous thromboembolism (VTE). We evaluated the influence of anemia among 3012 patients in the COMMAND VTE Registry with a median follow-up period of 1219 days. The outcomes measures were ISTH major bleeding, recurrent VTE and all-cause death. There were 1012 patients (34%) with moderate/severe anemia (Hb ≤ 10.9 g/dl), 615 patients (20%) with mild anemia (Hb 11.0-12.9 g/dl for men, and 11.0-11.9 g/dl for women), and 1385 patients (46%) without anemia. The cumulative 5-year incidence of major bleeding was significantly higher in patients with anemia (moderate/severe anemia: 17.6%, mild anemia: 12.1%, and no anemia: 8.7%, P < 0.001). After adjusting the confounders, the excess risk of mild and moderate/severe anemia, respectively, relative to no anemia for major bleeding remained significant (mild: adjusted HR 1.41: [95% CI 1.00-1.98], P = 0.048; moderate/severe: adjusted HR 1.91: [95% CI 1.42-2.58], P < 0.001, respectively). The excess risk of moderate/severe anemia relative to no anemia was also significant for mortality (adjusted HR 2.89: 95% CI 2.45-3.42, P < 0.001), but the risk was neutral for recurrent VTE (adjusted HR 1.05: 95% CI 0.76-1.45, P = 0.77). In conclusions, VTE patients with mild and moderate/severe anemia had higher risk for major bleeding events without significant excess risk for recurrent VTE events, and the risk for major bleeding events increased according to the severity of anemia. We should pay more attention to the optimal intensity and duration of anticoagulation in VTE patients with anemia.
贫血对静脉血栓栓塞症（VTE）患者的长期临床结局的影响尚未得到充分评估。我们评估了在 COMMAND VTE 登记处的 3012 例患者中贫血的影响，中位随访时间为 1219 天。结局指标为 ISTH 大出血、复发性 VTE 和全因死亡。有 1012 例（34%）患者为中重度贫血（Hb≤10.9g/dl），615 例（20%）为轻度贫血（男性 Hb 为 11.0-12.9g/dl，女性 Hb 为 11.0-11.9g/dl），1385 例（46%）患者无贫血。贫血患者的 5 年累积大出血发生率显著更高（中重度贫血：17.6%，轻度贫血：12.1%，无贫血：8.7%，P<0.001）。在校正混杂因素后，与无贫血相比，轻度和中重度贫血分别发生大出血的风险仍然显著增加（轻度：校正 HR 1.41：[95%CI 1.00-1.98]，P=0.048；中重度：校正 HR 1.91：[95%CI 1.42-2.58]，P<0.001）。与无贫血相比，中重度贫血患者的死亡率风险也显著增加（校正 HR 2.89：95%CI 2.45-3.42，P<0.001），但对复发性 VTE 的风险无显著影响（校正 HR 1.05：95%CI 0.76-1.45，P=0.77）。总之，轻度和中重度贫血的 VTE 患者大出血事件风险较高，但复发性 VTE 事件风险无显著增加，且大出血事件风险随贫血严重程度增加而增加。我们应更加关注贫血 VTE 患者抗凝的最佳强度和持续时间。
