Aleidan Fahad A S
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Anticoagulation Clinic, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Vasc Health Risk Manag. 2020 Oct 19;16:437-443. doi: 10.2147/VHRM.S264814. eCollection 2020.
Incidence and outcomes of recurrent venous thromboembolism (VTE) in the elderly are still not fully elucidated. The purpose of this study was to determine the incidence and identify the risk factors of VTE recurrence in this population.
A prospective cohort study of a one-year follow-up of 277 patients aged ≥65 years with primary VTE was performed at King Abdulaziz Medical City, a tertiary care teaching hospital in Riyadh, Saudi Arabia. Demographic data, risk factors, and the consequences of VTE (recurrence, bleeding, and mortality) were recorded.
Of the 277 VTE patients, 39 (14%) were diagnosed with recurrent VTE over a median follow-up period of 12 months. The cumulative incidence of recurrent VTE was 12.75 per hundred patient-year (95% CI, 8.24-17.36). In multivariate Cox regression, malignancy (hazard ratio [HR], 2.87, 95% CI, 1.32-6.24, =0.008) and surgery (HR 2.78, 95% CI, 1.36-5.67, =0.005) were identified as independent risk factors for recurrent VTE. Metformin had a significant independent protection effect (HR, 0.16, 95% CI, 0.08-0.33, <0.001). During follow-up, two patients in the recurrent VTE group and five patients in the group with no recurrent VTE, all of whom were minor bleeding cases, reported no major bleeding. Seven (18%) patients in the recurrent VTE group and nine (4%) patients in the group with no recurrent VTE died (p<0.001).
The findings of this study show that elderly patients with initial VTE have a recurrent rate (14%), with a cumulative incidence rate of 12.75 per hundred patient-year. Malignancy and surgery were the most important clinical risk factors to impact significantly the development of recurrent VTE in our elderly population. Metformin may have a protective effect against recurrent VTE in the elderly population, and a larger study is needed to validate our findings.
老年人复发性静脉血栓栓塞症（VTE）的发病率和转归仍未完全阐明。本研究的目的是确定该人群中VTE复发的发病率并识别其风险因素。
在沙特阿拉伯利雅得的一家三级医疗教学医院阿卜杜勒阿齐兹国王医疗城，对277例年龄≥65岁的原发性VTE患者进行了为期一年的前瞻性队列研究。记录人口统计学数据、风险因素以及VTE的后果（复发、出血和死亡）。
在277例VTE患者中，39例（14%）在中位随访期12个月时被诊断为复发性VTE。复发性VTE的累积发病率为每100患者年12.75例（95%CI，8.24 - 17.36）。在多变量Cox回归分析中，恶性肿瘤（风险比[HR]，2.87，95%CI，1.32 - 6.24，P = 0.008）和手术（HR 2.78，95%CI，1.36 - 5.67，P = 0.005）被确定为复发性VTE的独立风险因素。二甲双胍具有显著的独立保护作用（HR，0.16，95%CI，0.08 - 0.33，P < 0.001）。在随访期间，复发性VTE组有2例患者，无复发性VTE组有5例患者报告有轻微出血，均无大出血情况。复发性VTE组有7例（18%）患者死亡，无复发性VTE组有9例（4%）患者死亡（P < 0.001）。
本研究结果表明，初发VTE的老年患者复发率为14%，累积发病率为每100患者年12.75例。恶性肿瘤和手术是对我们老年人群复发性VTE的发生有显著影响的最重要临床风险因素。二甲双胍可能对老年人群复发性VTE有保护作用，需要开展更大规模的研究来验证我们的研究结果。
