Janssen Scientific Affairs, LLC, Titusville, New Jersey.
Georgetown University Medical Center, Washington, DC, USA.
Blood Coagul Fibrinolysis. 2022 Sep 1;33(6):301-309. doi: 10.1097/MBC.0000000000001140. Epub 2022 Jul 5.
This study was conducted in patients treated for initial venous thromboembolism (VTE) for approximately 6 months to enhance understanding of the risk factors to inform clinical decision-making about long-term anticoagulation therapy. This retrospective cohort study was conducted using a large administrative claims database in the United States. A Cox proportional hazards model was used to examine demographic and clinical characteristics associated with recurrent VTE. A total of 13 831 patients had an index VTE event, and recurrent VTE occurred in 844 (6.1%) of these patients over a median follow-up of 22.8 months. Baseline comorbidities of arrhythmia, congestive heart failure, and chronic kidney disease were significantly associated with recurrent VTE. During the period of anticoagulation treatment after the index VTE, use of antidepressants was associated with an increased risk of recurrent VTE, whereas use of antibiotics and major surgery were associated with a decreased risk. In the 6 months prior to index VTE, anti-inflammatory agents and major surgery were associated with a decreased risk of recurrent VTE. The type of index VTE was also significantly associated with recurrent VTE, with an increased risk observed in patients with pulmonary embolism (PE) alone or PE with deep vein thrombosis (DVT) versus DVT alone. This real-world analysis identified baseline comorbidities, medications, and index VTE type to be factors predictive of recurrent VTE among patients treated for index VTE for approximately 6 months. Consideration of these factors may assist in the identification of patients who may benefit from extended anticoagulant therapy.
本研究纳入了约 6 个月初始静脉血栓栓塞症（VTE）治疗的患者，旨在深入了解风险因素，为长期抗凝治疗的临床决策提供信息。这是一项在美国大型行政索赔数据库中进行的回顾性队列研究。采用 Cox 比例风险模型分析与复发性 VTE 相关的人口统计学和临床特征。共有 13831 例患者发生首发 VTE 事件，其中 844 例（6.1%）患者在中位随访 22.8 个月时发生复发性 VTE。基线合并症心律失常、充血性心力衰竭和慢性肾脏病与复发性 VTE 显著相关。在首发 VTE 后抗凝治疗期间，使用抗抑郁药与复发性 VTE 的风险增加相关，而使用抗生素和大手术与风险降低相关。在首发 VTE 前 6 个月，抗炎药和大手术与复发性 VTE 的风险降低相关。首发 VTE 的类型也与复发性 VTE 显著相关，与单独肺栓塞（PE）或 PE 合并深静脉血栓形成（DVT）与单纯 DVT 相比，PE 患者的风险增加。这项真实世界分析确定了基线合并症、药物和首发 VTE 类型是治疗首发 VTE 约 6 个月患者复发性 VTE 的预测因素。考虑这些因素可能有助于确定可能受益于延长抗凝治疗的患者。
