Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing.
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing.
Am J Med. 2021 Jul;134(7):877-881. doi: 10.1016/j.amjmed.2020.11.013. Epub 2020 Dec 11.
Whether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity deep venous thrombosis is not known.
This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016, 2017. Patients hospitalized with a primary diagnosis of deep venous thrombosis at known locations were identified by International Classification of Diseases-10-Clinical Modification codes.
In-hospital all-cause mortality with deep venous thrombosis involving the inferior vena cava in patients treated only with anticoagulants was 2.2% versus 0.8% with pelvic vein deep venous thrombosis (p<0.0001), 0.7% with proximal deep venous thrombosis (p<0.0001) and 0.2% with distal deep venous thrombosis (p<0.0001). Mortality with anticoagulants was similar with pelvic vein deep venous thrombosis compared with proximal lower extremity deep venous thrombosis, 0.8% versus 0.7% (p=0.39). Lower mortality was shown with pelvic vein deep venous thrombosis treated with thrombolytics than with anticoagulants, 0% versus 0.8% (p<0.0001). In-hospital pulmonary embolism occurred in 11% to 23%, irrespective of the site of deep venous thrombosis.
Patients with deep venous thrombosis involving the inferior vena cava had higher in-hospital mortality than patients with deep venous thrombosis at other locations. Pelvic vein deep venous thrombosis did not result in higher mortality or more in-hospital pulmonary embolism than proximal lower extremity deep venous thrombosis. The incidence of in-hospital pulmonary embolism was considerable with deep venous thrombosis at all sites.
与近端或远端下肢深静脉血栓形成相比，累及盆腔静脉或下腔静脉的深静脉血栓形成是否与更高的住院内死亡率或更高的住院内肺栓塞发生率相关尚不清楚。
这是一项基于 2016 年和 2017 年全国住院患者样本的回顾性队列研究。通过国际疾病分类-10-临床修正代码识别出在已知部位因深静脉血栓形成而住院的患者。
仅接受抗凝治疗的患者中，下腔静脉深静脉血栓形成的住院内全因死亡率为 2.2%，而盆腔静脉深静脉血栓形成的死亡率为 0.8%（p<0.0001），近端深静脉血栓形成的死亡率为 0.7%（p<0.0001），远端深静脉血栓形成的死亡率为 0.2%（p<0.0001）。与近端下肢深静脉血栓形成相比，盆腔静脉深静脉血栓形成用抗凝剂治疗的死亡率相似，分别为 0.8%和 0.7%（p=0.39）。与用抗凝剂治疗相比，用溶栓剂治疗的盆腔静脉深静脉血栓形成的死亡率较低，分别为 0%和 0.8%（p<0.0001）。无论深静脉血栓形成的部位如何，住院内肺栓塞的发生率均为 11%至 23%。
与其他部位深静脉血栓形成的患者相比，下腔静脉深静脉血栓形成的患者住院内死亡率更高。与近端下肢深静脉血栓形成相比，盆腔静脉深静脉血栓形成并未导致更高的死亡率或更多的住院内肺栓塞。在所有部位均存在深静脉血栓形成的情况下，住院内肺栓塞的发生率相当高。
