Wang Huijie, Rosendaal Frits R, Cushman Mary, van Hylckama Vlieg Astrid
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
J Thromb Haemost. 2021 Jan;19(1):186-193. doi: 10.1111/jth.15127. Epub 2020 Dec 22.
Essentials Venous thrombosis (VT) risk and coagulation factor levels increase with age. We studied the association between levels of procoagulant factors and the risk of a first VT in the elderly. Higher levels of factors VIII, IX, and XI, but not prothrombin, were associated with the risk of VT. Similar risk patterns were observed for provoked and unprovoked VT and for deep vein thrombosis and pulmonary embolism separately. ABSTRACT: Background Venous thrombosis (VT) incidence increases markedly with age. Coagulation factors are also positively associated with age. Objective To study whether higher levels of coagulation factors II (prothrombin), VIII, IX, and XI are associated with risk of a first VT in the elderly. Methods Four hundred and one patients and 431 control subjects aged 70 and older were included in the Age and Thrombosis, Acquired and Genetic risk factors in the Elderly (AT-AGE) study. Blood was collected 1 year after the event in patients and in all control subjects for measurement of coagulation factors. To assess the risk of VT, odds ratios (ORs) were calculated after stratification of coagulation factors in quartiles and at the 90th percentile, adjusting for potential confounders (age, sex, body mass index, and study center). Results Mean age was 78 years (range: 70-100 years). The ORs of VT for factors in the top quartile compared with the lowest quartile were 4.5 (95% confidence interval [CI]:2.7-7.3) for factor VIII, 2.4 (95% CI:1.1-5.2) for factor IX, and 1.7 (95% CI:1.0-2.9) for factor XI. High prothrombin was not associated with an increased VT risk. There was no dose-response association between the number of high coagulation factors and VT risk. The population attributable risk (PAR) of VT was 37.6%, 23.3%, and 12.4% for factor VIII, IX, and XI, respectively. Conclusion In this study of the elderly, higher factors VIII, IX, and XI but not prothrombin, were positively associated with the risk of VT.
静脉血栓形成（VT）风险和凝血因子水平随年龄增长而增加。我们研究了促凝血因子水平与老年人首次发生VT风险之间的关联。VIII、IX和XI因子水平升高与VT风险相关，但凝血酶原水平升高与VT风险无关。对于诱发性和非诱发性VT以及分别对于深静脉血栓形成和肺栓塞，观察到了相似的风险模式。摘要：背景：静脉血栓形成（VT）的发病率随年龄显著增加。凝血因子也与年龄呈正相关。目的：研究凝血因子II（凝血酶原）、VIII、IX和XI水平升高是否与老年人首次发生VT的风险相关。方法：年龄与血栓形成、老年人获得性和遗传危险因素（AT-AGE）研究纳入了401例患者和431例70岁及以上的对照者。在事件发生1年后采集患者和所有对照者的血液以检测凝血因子。为评估VT风险，在将凝血因子分层为四分位数并处于第90百分位数后计算比值比（OR），并对潜在混杂因素（年龄、性别、体重指数和研究中心）进行调整。结果：平均年龄为78岁（范围：70 - 100岁）。与最低四分位数相比，VIII因子处于最高四分位数时VT的OR为4.5（95%置信区间[CI]：2.7 - 7.3），IX因子为2.4（95% CI：1.1 - 5.2），XI因子为1.7（95% CI：1.0 - 2.9）。高凝血酶原与VT风险增加无关。高凝血因子数量与VT风险之间不存在剂量反应关联。VIII、IX和XI因子导致VT的人群归因风险（PAR）分别为37.6%、23.3%和12.4%。结论：在这项针对老年人的研究中，较高的VIII、IX和XI因子而非凝血酶原与VT风险呈正相关。
