Méan Marie, Breakey Neal, Stalder Odile, Alberio Lorenzo, Limacher Andreas, Angelillo-Scherrer Anne, Fontana Pierre, Beer Hans Jürg, Rodondi Nicolas, Aujesky Drahomir, Lämmle Bernhard, Escher Robert
Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Department of Internal Medicine, Spital Emmental, Burgdorf, Switzerland.
Res Pract Thromb Haemost. 2022 Dec 16;7(1):100015. doi: 10.1016/j.rpth.2022.100015. eCollection 2023 Jan.
Limited data exist on thrombophilic risk factors and clinical outcomes in the elderly with venous thromboembolism (VTE).
To describe the prevalence of laboratory thrombophilic risk factors and their association with VTE recurrence or death in a cohort of elderly people with VTE.
In 240 patients aged ≥65 years with acute VTE without active cancer or an indication for extended anticoagulation, we performed laboratory thrombophilia testing 1 year after the index VTE. Recurrence or death was assessed during the 2-year follow-up.
A total of 78% of patients had ≥1 laboratory thrombophilic risk factor(s). Elevated levels of von Willebrand factor, homocysteine, coagulant activity of factor VIII (FVIII:C), fibrinogen, FIX:C, and low antithrombin activity were the most prevalent risk factors (43%, 30%, 15%, 14%, 13%, and 11%, respectively). Additionally, 16.2% of patients experienced VTE recurrence and 5.8% of patients died. Patients with a von Willebrand factor of >182%, FVIII:C level >200%, homocysteine level >15μmol/L, or lupus anticoagulant had a significantly higher rate of recurrence than those without these risk factors (15.0 vs. 6.1 [ = .006], 23.5 vs. 8.2 [ = .01], 17.0 vs. 6.8 [ = .006], and 89.5 vs. 9.2 [ = .02] events per 100 patient-years, respectively). Furthermore, patients with a high fibrinogen level or hyperhomocysteinemia with a homocysteine level ≥30 μmol/L had significantly higher mortality than patients with normal levels (18.5 vs. 2.8 [ = .049] and 13.6 vs. 2 [ = .002] deaths per 100 patient-years, respectively). After adjustments for relevant confounders, these associations remained unchanged.
Laboratory thrombophilic risk factors are common in elderly people with VTE and allow for the identification of a population at the risk of worse clinical outcomes.
关于老年静脉血栓栓塞症（VTE）患者的血栓形成倾向危险因素及临床结局的数据有限。
描述老年VTE患者实验室血栓形成倾向危险因素的患病率及其与VTE复发或死亡的关联。
在240例年龄≥65岁、患有急性VTE且无活动性癌症或无需长期抗凝治疗指征的患者中，我们在首次VTE发生1年后进行了实验室血栓形成倾向检测。在2年随访期间评估复发或死亡情况。
共有78%的患者存在≥1种实验室血栓形成倾向危险因素。血管性血友病因子、同型半胱氨酸、凝血因子VIII（FVIII:C）的凝血活性、纤维蛋白原、FIX:C水平升高以及抗凝血酶活性降低是最常见的危险因素（分别为43%、30%、15%、14%、13%和11%）。此外，16.2%的患者发生了VTE复发，5.8%的患者死亡。血管性血友病因子>182%、FVIII:C水平>200%、同型半胱氨酸水平>15μmol/L或存在狼疮抗凝物的患者复发率显著高于无这些危险因素的患者（每100患者年的事件发生率分别为15.0对6.1[P = .006]、23.5对8.2[P = .01]、17.0对6.8[P = .006]和89.5对9.2[P = .02]）。此外，纤维蛋白原水平高或同型半胱氨酸血症且同型半胱氨酸水平≥30μmol/L的患者死亡率显著高于水平正常的患者（每100患者年的死亡率分别为18.5对2.8[P = .049]和13.6对2[P = .002]）。在对相关混杂因素进行调整后，这些关联保持不变。
实验室血栓形成倾向危险因素在老年VTE患者中很常见，有助于识别临床结局较差风险的人群。
