Division of Vascular Medicine, Department of Cardiovascular Diseases.
Division of Hematology/Oncology, Department of Internal Medicine.
Blood. 2021 Jun 10;137(23):3284-3290. doi: 10.1182/blood.2020010231.
The calf muscle pump is a major determinate of venous return in the legs but has not been studied as a risk factor for venous thromboembolism (VTE). A population-based cohort study of Olmsted County, Minnesota residents was performed using calf pump function (CPF) measurements from venous plethysmography studies from 1998 to 2015. Patients with a history of VTE were excluded. Nursing validated VTE outcomes from the Rochester Epidemiology Project were identified after the index study date, and patients with reduced CPF (rCPF) were compared with patients with normal CPF. A total of 1532 patients with recorded CPF (28% air and 72% strain gauge plethysmography) were included; 591 (38.5%) had normal CPF, 353 (23.0%) had unilateral rCPF, and 588 (38.3%) had bilateral rCPF. Any VTE occurred in 87 patients (5.7%) after a median follow-up of 11.7 years (range, 0-22.0 years). Comparing patients with bilateral reduced to bilateral normal CPF, the unadjusted hazard ratio (HR) for incident VTE was 2.0 (95% confidence interval [CI], 1.2-3.4) and after adjusting for age, BMI, and Charlson Comorbidity Index, the HR was 1.68 (95% CI, 0.98-2.89). The adjusted HR for ipsilateral deep vein thrombosis was evaluated in 3064 legs comparing legs with reduced to normal CPF and was 1.71 (95% CI, 1.03-2.84). Mortality was significantly higher in both the bilateral (P < .001) and unilateral (P < .001) rCPF groups compared with normal CPF. Our results demonstrate that CPF is a risk factor for VTE in an otherwise low-risk ambulatory population and might be a useful component in risk stratification models.
小腿肌肉泵是腿部静脉回流的主要决定因素，但尚未作为静脉血栓栓塞症（VTE）的危险因素进行研究。对明尼苏达州奥姆斯特德县的居民进行了一项基于人群的队列研究，使用从 1998 年至 2015 年的静脉容积描记术研究中的小腿泵功能（CPF）测量值。排除有 VTE 病史的患者。在指数研究日期之后，从罗切斯特流行病学项目中确定了经护理验证的 VTE 结局，并且将 CPF 降低的患者（rCPF）与 CPF 正常的患者进行了比较。共纳入 1532 例记录 CPF（28%空气和 72%应变计容积描记术）的患者；591 例（38.5%）CPF 正常，353 例（23.0%）单侧 rCPF，588 例（38.3%）双侧 rCPF。中位随访 11.7 年（范围 0-22.0 年）后，87 例（5.7%）患者发生任何 VTE。与双侧 rCPF 相比，双侧 CPF 正常患者发生 VTE 的未调整风险比（HR）为 2.0（95%置信区间 [CI]，1.2-3.4），在调整年龄、BMI 和 Charlson 合并症指数后，HR 为 1.68（95% CI，0.98-2.89）。在比较 rCPF 降低与 CPF 正常的 3064 条腿后，评估了同侧深静脉血栓形成的调整 HR，为 1.71（95% CI，1.03-2.84）。与 CPF 正常的患者相比，双侧 rCPF（P <.001）和单侧 rCPF（P <.001）的死亡率均显著更高。我们的结果表明，CPF 是低危门诊人群中 VTE 的危险因素，并且可能是风险分层模型中的有用组成部分。
