Ha Hyerim, Kim Ki Hwan, Park Jin Hyun, Lee Jung Kyu, Heo Eun Young, Kim Jin Soo, Kim Deog Kyeom, Choi In Sil, Chung Hee Soon, Lim Hyo Jeong
Division of Hematology and Medical Oncology, Department of Internal medicine, Seoul National University Hospital, Seoul, Korea.
Division of Hematology and Medical Oncology, Department of Internal medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea.
Infect Chemother. 2019 Jun;51(2):142-149. doi: 10.3947/ic.2019.51.2.142.
Tuberculosis is associated with hypercoagulation; however, there are few reports of cases thromboembolism and tuberculosis at the same time in the real world. The purpose of this study was to report the incidence and clinical course of thromboembolism in patients diagnosed with tuberculosis.
We retrospectively analyzed the data of patients who were diagnosed with both tuberculosis and thromboembolism including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) at Seoul National University Boramae Medical Center from January 2000 through March 2015.
Among the 7905 tuberculosis patients, 49 (0.6%) exhibited PTE, DVT, or both at or after the time of tuberculosis diagnosis. All patients treated for tuberculosis started with isoniazid, ethambutol, rifampicin, and pyrazinamide. Eight patients were switched to treatment with second-line medication because of resistance or adverse events. About half of the patients (n = 21, 44.7%) had thrombosis at the time of tuberculosis diagnosis. Of 48 patients treated for thromboembolism, 36 received warfarin. A total of 20 patients improved symptom caused by thrombosis, and 10 patients were confirmed cure by image study such as computed tomography or doppler ultrasonography. Eight patients who were treated with warfarin had persistent thrombosis. Five patients (10.2%) experienced major bleeding that required hospitalization. All of these bleeding events were associated with warfarin therapy.
Careful attention to PTE/DVT is needed at the time of diagnosis of tuberculosis and during anti-tuberculosis therapy. Warfarin therapy administered with anti-tuberculosis medication requires frequent monitoring to prevent major bleeding.
结核病与高凝状态有关；然而，在现实世界中，同时发生血栓栓塞和结核病的病例报告很少。本研究的目的是报告结核病患者血栓栓塞的发生率和临床病程。
我们回顾性分析了2000年1月至2015年3月在首尔国立大学博拉梅医疗中心被诊断为同时患有结核病和血栓栓塞（包括肺血栓栓塞症（PTE）或深静脉血栓形成（DVT））的患者的数据。
在7905例结核病患者中，49例（0.6%）在结核病诊断时或之后出现PTE、DVT或两者皆有。所有接受结核病治疗的患者均开始使用异烟肼、乙胺丁醇、利福平及吡嗪酰胺。8例患者因耐药或不良事件改用二线药物治疗。约一半患者（n = 21，44.7%）在结核病诊断时已发生血栓形成。在48例接受血栓栓塞治疗的患者中，36例接受了华法林治疗。共有20例患者血栓形成引起的症状得到改善，10例患者经计算机断层扫描或多普勒超声等影像学检查证实治愈。8例接受华法林治疗的患者血栓持续存在。5例患者（10.2%）发生需要住院治疗的大出血。所有这些出血事件均与华法林治疗有关。
在结核病诊断时及抗结核治疗期间，需要密切关注PTE/DVT。华法林与抗结核药物联合使用时，需要频繁监测以预防大出血。
