Nilius Henning, Mertins Tamara, Boss Robin, Knuchel Matthias, Blozik Eva, Kremer Hovinga Johanna Anna, Eichinger Sabine, Nagler Michael
University Institute of Clinical Chemistry, Inselspital University Hospital, University of Bern, Bern, Switzerland.
Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
Front Cardiovasc Med. 2021 Oct 1;8:749342. doi: 10.3389/fcvm.2021.749342. eCollection 2021.
Little is known about long-term survival after the initial treatment of venous thromboembolism (VTE). In a prospective cohort study, we aimed to assess the long-term mortality and key predictor variables relating to disease severity, treatment intensity, and comorbidities. Between 1988 and 2018, 6,243 consecutive patients with VTE from a University outpatient unit were prospectively included and followed until December 2019; clinical characteristics, measures of disease severity, and treatment details were recorded. Dates of death were retrieved from the Swiss Central Compensation Office. Overall, 254 deaths occurred over an observation period of 57,212 patient-years. Compared to the Swiss population, the standardized mortality ratio was 1.30 (95% CI: 1.14, 1.47; overall mortality rate: 4.44 per 1,000 patient-years). The following predictors were associated with increased mortality: Unprovoked VTE (hazard ratio [HR]: 5.06; 95% CI: 3.29, 7.77), transient triggering risk factors (HR: 3.46; 95% CI: 2.18, 5.48), previous VTE (HR: 2.05; 95% CI: 1.60, 2.62), pulmonary embolism (HR: 1.45, 95% CI: 1.10, 1.89), permanent anticoagulant treatment (HR: 3.14; 95% CI: 2.40, 4.12), prolonged anticoagulant treatment (7-24 months; HR: 1.70; 95% CI: 1.16, 2.48), and cardiovascular comorbidities. Unprovoked VTE, previous VTE, permanent and prolonged anticoagulation remain independent risk factors after adjustment for age, sex, and comorbidities. Survival after VTE was significantly reduced compared to the Swiss general population, especially in patients with more severe disease, cardiovascular comorbidities, and longer anticoagulant treatment.
关于静脉血栓栓塞症（VTE）初始治疗后的长期生存情况，人们了解甚少。在一项前瞻性队列研究中，我们旨在评估长期死亡率以及与疾病严重程度、治疗强度和合并症相关的关键预测变量。1988年至2018年期间，前瞻性纳入了某大学门诊连续6243例VTE患者，并随访至2019年12月；记录了临床特征、疾病严重程度指标和治疗细节。死亡日期从瑞士中央赔偿办公室获取。总体而言，在57212患者年的观察期内发生了254例死亡。与瑞士人群相比，标准化死亡率为1.30（95%CI：1.14，1.47；总死亡率：每1000患者年4.44例）。以下预测因素与死亡率增加相关：特发性VTE（风险比[HR]：5.06；95%CI：3.29，7.77）、短暂触发风险因素（HR：3.46；95%CI：2.18，5.48）、既往VTE（HR：2.05；95%CI：1.60，2.62）、肺栓塞（HR：1.45，95%CI：1.10，1.89）、长期抗凝治疗（HR：3.14；95%CI：2.40，4.12）、延长抗凝治疗（7 - 24个月；HR：1.70；95%CI：1.16，2.48）以及心血管合并症。在对年龄、性别和合并症进行调整后，特发性VTE、既往VTE、长期和延长抗凝治疗仍然是独立的风险因素。与瑞士普通人群相比，VTE后的生存率显著降低，尤其是在疾病更严重、有心血管合并症以及抗凝治疗时间更长的患者中。
