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青年人群静脉血栓栓塞症的特征、治疗和结局:来自血栓栓塞疾病信息化登记处的研究结果。

Venous thromboembolism characteristics, treatment and outcomes in young adults: findings from the Registro Informatizado de Enfermedad TromboEmbólica registry.

机构信息

National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel; Amalia Biron Research Institute of Thrombosis and Hemostasis, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine and Surgery, University of Insubria, Varese, Italy.

National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel; Amalia Biron Research Institute of Thrombosis and Hemostasis, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

J Thromb Haemost. 2023 Oct;21(10):2811-2823. doi: 10.1016/j.jtha.2023.06.031. Epub 2023 Jul 3.

Abstract

BACKGROUND

Venous thromboembolism (VTE) is rare in patients aged <21 years. Young adults aged 18 to 21 years are frequently included in adult VTE studies, whereas pediatric VTE studies include patients aged up to either 18 or 21 years. The clinical characteristics of young adult patients with VTE have not been well defined.

OBJECTIVES

We aimed to highlight any unique characteristics or treatment considerations that may apply to young adult patients with VTE.

METHODS

Data from the prospective, international Registro Informatizado de Enfermedad TromboEmbólica registry were used. Patients were stratified into subcohorts according to age. The clinical characteristics, risk factors, management, and outcomes of young adult patients with VTE were compared with those of adolescents aged 12 to 18 years and adults aged >21 years.

RESULTS

Of 104 253 Registro Informatizado de Enfermedad TromboEmbólica patients enrolled until August 2022, 234 were adolescents and 884 were young adults. Less cases of pulmonary embolism were reported in adolescents (P < .001). Estrogen use was a common risk factor, more prevalent in adolescents and young adults (P < .001), whereas active cancer and immobilization were uncommon in both. Most patients were initially treated with low-molecular-weight heparin. VTE recurrence, major bleeding, and all-cause mortality rates were comparably low among adolescents and young adults. None of the patients aged <21 years died from VTE recurrence.

CONCLUSION

Young adults have some distinctive VTE risk factors. While VTE presentation may be similar among young adults and older patients, the outcomes of patients aged <21 years are more favorable.

摘要

背景

静脉血栓栓塞症(VTE)在<21 岁的患者中很少见。18 至 21 岁的年轻成年人经常被纳入成人 VTE 研究,而儿科 VTE 研究则包括年龄在 18 岁或 21 岁以下的患者。年轻成年患者 VTE 的临床特征尚未得到很好的定义。

目的

我们旨在强调可能适用于年轻成年 VTE 患者的任何独特特征或治疗注意事项。

方法

使用前瞻性国际血栓栓塞登记处的登记数据。根据年龄将患者分层为亚组。比较年轻成年 VTE 患者与 12 至 18 岁青少年和>21 岁成人的临床特征、危险因素、管理和结局。

结果

截至 2022 年 8 月,登记处共纳入 104253 例患者,其中青少年患者 234 例,年轻成年患者 884 例。青少年患者中报告的肺栓塞病例较少(P<0.001)。雌激素使用是常见的危险因素,在青少年和年轻成年人中更为常见(P<0.001),而在两者中,活动期癌症和固定均不常见。大多数患者最初接受低分子量肝素治疗。青少年和年轻成年人的 VTE 复发、大出血和全因死亡率相当低。<21 岁的患者无一例因 VTE 复发而死亡。

结论

年轻成年人有一些独特的 VTE 危险因素。尽管年轻成年患者和老年患者的 VTE 表现可能相似,但<21 岁患者的结局更为有利。

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