Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands.
JAMA Netw Open. 2019 May 3;2(5):e193690. doi: 10.1001/jamanetworkopen.2019.3690.
The size of the risk of recurrent venous thromboembolism (VTE) after surgery in patients with a history of VTE is not well known.
To estimate the risk of and to identify the factors associated with recurrent VTE in patients undergoing surgery who have a history of VTE.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, follow-up cohort study includes patients with VTE who participated in the Multiple Environment and Genetic Assessment (MEGA) study. Original data were collected from March 1999 to April 2010. Data analysis began in June 1999 and ended in April 2010.
Surgery following a first VTE.
Kaplan-Meier analyses were used to estimate cumulative incidences of recurrent VTE. Cox regression with a time-dependent covariate (surgery) was used to calculate the hazard ratio (HR) for developing recurrent VTE after surgery compared with no surgery.
Overall, 3741 patients (mean [SD] age, 48.4 [12.8] years; 2020 [54.0%] women) with a history of VTE were included in the analysis, amounting to 18 899 person-years, with a median (interquartile range) follow-up of 5.7 (3.0-7.2) years. Of the 3741 patients, 580 (15.5%) underwent surgery and 601 (16.1%) developed a recurrent thrombotic event. The 1-month cumulative incidence of recurrent VTE for all surgery types was 2.1% (95% CI, 1.2%-3.6%), which increased to 3.3% (95% CI, 2.1%-5.1%) at 3 months and 4.6% (95% CI, 3.1%-6.6%) at 6 months. At 6 months, risk of recurrent VTE ranged from 2.3% to 9.3%, depending on surgery type. In addition to surgery type, factor V Leiden mutation (HR, 3.4; 95% CI, 1.6-7.4) and male sex (HR, 2.7; 95% CI, 1.3-5.8) were associated with increased risk of recurrent VTE.
Surgery was associated with an increased risk of recurrent VTE in patients with a history of VTE; risk remained high for up to 6 months after the procedure. This study suggests that high-risk individuals may be identified based on surgery type, sex, and the presence of factor V Leiden mutation. These findings stress the need for revision of the current thromboprophylactic approach to prevent recurrence in these patients.
有静脉血栓栓塞症 (VTE) 病史的患者手术后发生复发性静脉血栓栓塞症 (VTE) 的风险大小尚不清楚。
评估有 VTE 病史的患者手术后发生复发性 VTE 的风险，并确定相关因素。
设计、环境和参与者：这是一项基于人群的随访队列研究，纳入了参加多环境和遗传评估 (MEGA) 研究的 VTE 患者。原始数据收集于 1999 年 3 月至 2010 年 4 月。数据分析于 1999 年 6 月开始，2010 年 4 月结束。
VTE 后行手术。
Kaplan-Meier 分析用于估计复发性 VTE 的累积发生率。Cox 回归分析采用时间依赖性协变量（手术）来计算手术后与未手术相比发生复发性 VTE 的风险比 (HR)。
共纳入 3741 例（平均[SD]年龄 48.4[12.8]岁；2020 例[54.0%]为女性）有 VTE 病史的患者，共 18899 人年，中位（四分位间距）随访时间为 5.7（3.0-7.2）年。在 3741 例患者中，580 例（15.5%）接受了手术，601 例（16.1%）发生了复发性血栓事件。所有手术类型的 1 个月复发性 VTE 累积发生率为 2.1%（95%CI，1.2%-3.6%），3 个月时增至 3.3%（95%CI，2.1%-5.1%），6 个月时增至 4.6%（95%CI，3.1%-6.6%）。6 个月时，手术类型不同，复发性 VTE 的风险为 2.3%-9.3%。除手术类型外，因子 V 莱顿突变（HR，3.4；95%CI，1.6-7.4）和男性（HR，2.7；95%CI，1.3-5.8）也与复发性 VTE 风险增加相关。
有 VTE 病史的患者手术后发生复发性 VTE 的风险增加；手术后 6 个月内风险仍然很高。本研究提示可根据手术类型、性别和因子 V 莱顿突变情况识别高危人群。这些发现强调需要修订当前的血栓预防策略，以防止这些患者复发。
