Department of Internal Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy.
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain.
Chest. 2020 Jun;157(6):1617-1625. doi: 10.1016/j.chest.2019.12.040. Epub 2020 Jan 29.
The influence of morbid obesity on mortality in patients receiving anticoagulant therapy for VTE has not been consistently evaluated.
Data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry were used to compare the mortality risk during anticoagulation in patients with VTE and morbid obesity (BMI ≥ 40 kg/m) vs those with normal weight (BMI, 18.5-24.9 kg/m). Patients with or without active cancer were analyzed separately.
By September 2018, there were 1,642 patients with VTE and morbid obesity and 14,848 with normal weight in RIETE. Of these, 245 (5.5%) and 1,397 (11.6%), respectively, had cancer. Median duration of anticoagulant therapy was longer in the morbidly obese patients, with cancer (185 vs 114 days) or without cancer (203 vs 177 days). Among cancer patients, 44 (18.0%) morbidly obese and 1,377 (32.8%) patients with normal weight died during anticoagulation. Among those without cancer, 44 (3.1%) morbidly obese died and 601 (5.6%) with normal weight died. On bivariate analysis, morbid obesity was associated with a lower mortality rate, both in patients with cancer (hazard ratio, 0.34; 95% CI, 0.25-0.45) and in those without cancer (hazard ratio, 0.43; 95% CI, 0.32-0.58). Multivariable analysis confirmed a lower hazard of death in morbidly obese patients with cancer (hazard ratio, 0.68; 95% CI, 0.50-0.94) and without cancer (hazard ratio, 0.67; 95% CI, 0.49-0.96). The risk for VTE recurrences or major bleeding did not differ in patients with or without morbid obesity.
In patients with VTE, the risk for death during anticoagulation was about one-third lower in morbidly obese patients than in those with normal weight, independently of the presence of cancer.
病态肥胖对接受抗凝治疗的 VTE 患者死亡率的影响尚未得到一致评估。
使用 RIETE（血栓栓塞疾病登记处）登记处的数据，比较 VTE 合并病态肥胖（BMI≥40kg/m²）与体重正常（BMI，18.5-24.9kg/m²）患者抗凝期间的死亡风险。分别分析有或无活动性癌症的患者。
截至 2018 年 9 月，RIETE 中有 1642 例 VTE 合并病态肥胖患者和 14848 例体重正常患者。其中，分别有 245（5.5%）和 1397 例（11.6%）患有癌症。病态肥胖患者的抗凝治疗时间中位数较长，有癌症（185 天）或无癌症（203 天）。在癌症患者中，有 44 例（18.0%）病态肥胖患者和 1377 例（32.8%）体重正常患者在抗凝期间死亡。在无癌症患者中，有 44 例（3.1%）病态肥胖患者死亡和 601 例（5.6%）体重正常患者死亡。在单变量分析中，病态肥胖与癌症患者（风险比，0.34；95%CI，0.25-0.45）和无癌症患者（风险比，0.43；95%CI，0.32-0.58）的死亡率较低相关。多变量分析证实，癌症患者（风险比，0.68；95%CI，0.50-0.94）和无癌症患者（风险比，0.67；95%CI，0.49-0.96）中病态肥胖患者的死亡风险较低。有或无病态肥胖的患者的 VTE 复发或大出血风险无差异。
在 VTE 患者中，病态肥胖患者的抗凝期间死亡风险比体重正常患者低约三分之一，与癌症的存在无关。
