Vrotniakaite-Bajerciene Kristina, Rütsche Sereina, Calzavarini Sara, Quarroz Claudia, Stalder Odile, Mean Marie, Righini Marc, Staub Daniel, Beer Juerg H, Frauchiger Beat, Osterwalder Joseph, Kucher Nils, Matter Christian M, Husmann Marc, Banyai Martin, Aschwanden Markus, Mazzolai Lucia, Hugli Olivier, Rodondi Nicolas, Aujesky Drahomir, Angelillo-Scherrer Anne
Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Department for BioMedical Research, University of Bern, 3010 Bern, Switzerland.
J Clin Med. 2023 Sep 19;12(18):6050. doi: 10.3390/jcm12186050.
It is currently unknown whether thrombin generation is associated with venous thromboembolism (VTE) recurrence, major bleeding, or mortality in the elderly. Therefore, our aim was to prospectively study the association between thrombin generation and VTE recurrence, major bleeding, and mortality in elderly patients with acute VTE. Consecutive patients aged ≥65 years with acute VTE were followed for 2 years, starting from 1 year after the index VTE. Primary outcomes were VTE recurrence, major bleeding, and mortality. Thrombin generation was assessed in 551 patients 1 year after the index VTE. At this time, 59% of the patients were still anticoagulated. Thrombin generation was discriminatory for VTE recurrence, but not for major bleeding and mortality in non-anticoagulated patients. Moreover, peak ratio (adjusted subhazard ratio 4.09, 95% CI, 1.12-14.92) and normalized peak ratio (adjusted subhazard ratio 2.18, 95% CI, 1.28-3.73) in the presence/absence of thrombomodulin were associated with VTE recurrence, but not with major bleeding and mortality after adjustment for potential confounding factors. In elderly patients, thrombin generation was associated with VTE recurrence, but not with major bleeding and/or mortality. Therefore, our study suggests the potential usefulness of thrombin generation measurement after anticoagulation completion for VTE to help identify among elderly patients those at higher risk of VTE recurrence.
目前尚不清楚凝血酶生成是否与老年人静脉血栓栓塞症（VTE）复发、大出血或死亡率相关。因此，我们的目的是前瞻性研究急性VTE老年患者中凝血酶生成与VTE复发、大出血和死亡率之间的关联。从首次VTE事件发生1年后开始，对年龄≥65岁的急性VTE连续患者进行为期2年的随访。主要结局为VTE复发、大出血和死亡率。在首次VTE事件发生1年后，对551例患者进行了凝血酶生成评估。此时，59%的患者仍在接受抗凝治疗。凝血酶生成对未接受抗凝治疗患者的VTE复发具有鉴别意义，但对大出血和死亡率无鉴别意义。此外，在存在/不存在血栓调节蛋白的情况下，峰值比（调整后亚风险比4.09，95%CI，1.12 - 14.92）和标准化峰值比（调整后亚风险比2.18，95%CI，1.28 - 3.73）与VTE复发相关，但在对潜在混杂因素进行调整后，与大出血和死亡率无关。在老年患者中，凝血酶生成与VTE复发相关，但与大出血和/或死亡率无关。因此，我们的研究表明，在完成抗凝治疗后测量凝血酶生成可能有助于识别老年患者中VTE复发风险较高的人群。
