Ruiz-Artacho Pedro, Trujillo-Santos Javier, López-Jiménez Luciano, Font Carme, Díaz-Pedroche María Del Carmen, Sánchez Muñoz-Torrero Juan Francisco, Peris Maria Luisa, Skride Andris, Maestre Ana, Monreal Manuel
Department of Emergency, Hospital Clínico San Carlos, Madrid, Spain.
Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain.
TH Open. 2018 Jun 1;2(2):e210-e217. doi: 10.1055/s-0038-1656542. eCollection 2018 Apr.
The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated. We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE. As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility. Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.
肺癌合并静脉血栓栓塞症（VTE）患者的自然病史尚未得到一致评估。我们使用RIETE（静脉血栓栓塞疾病信息登记库）数据库来评估急性、有症状VTE的肺癌患者在抗凝治疗期间的临床特征、病程及转归。截至2017年5月，共纳入1725例患者：1208例（70%）表现为肺栓塞（PE），517例表现为深静脉血栓形成（DVT）。总体而言，865例患者（50%）在诊断癌症后<3个月出现VTE，1270例（74%）有转移，1250例（72%）无其他VTE危险因素。在抗凝治疗期间（中位时间93天），166例患者出现有症状的VTE复发（复发性DVT：86例，PE：80例），63例发生大出血（颅内出血11例），870例死亡。复发率在第一个月比大出血率高两倍，在第一个月之后则高出三倍多。57例患者死于PE，15例死于出血。大多数致命性PE（84%）和大多数致命性出血（67%）发生在治疗的第一个月内。9例致命性PE患者（16%）在最初24小时内死亡。在死于PE或出血的72例患者中，15例（21%）无转移，29例（40%）在手术后或制动后不久发生VTE。对近期诊断为肺癌的患者积极监测VTE的早期体征和/或症状，并对接受手术或制动期间的患者进行预防性用药，可能有助于更好地预防VTE，更早地发现VTE并更有效地进行治疗。
