Internal Medicine Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Internal Medicine Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
J Thromb Haemost. 2024 Aug;22(8):2234-2246. doi: 10.1016/j.jtha.2024.05.007. Epub 2024 May 16.
The duration of anticoagulation for a first episode of unprovoked venous thromboembolism (VTE) should balance the likelihood of VTE recurrence against the risk of major bleeding.
Analyze rates and case-fatality rates (CFRs) of recurrent VTE and major bleeding after discontinuing anticoagulation in patients with a first unprovoked VTE after at least 3 months of anticoagulation.
We compared the rates and CFRs in patients of the Registro Informatizado Enfermedad Trombo Embólica (RIETE) and Contemporary management and outcomes in patients with venous thromboembolism registries. We used logistic regression models to identify predictors for recurrent pulmonary embolism (PE) and major bleeding.
Of 8261 patients with unprovoked VTE in RIETE registry, 4012 (48.6%) had isolated deep vein thrombosis (DVT) and 4250 had PE. Follow-up (median, 318 days) showed 543 recurrent DVTs, 540 recurrent PEs, 71 major bleeding episodes, and 447 deaths. The Contemporary management and outcomes in patients with venous thromboembolism registry yielded similar results. Corresponding CFRs of recurrent DVT, PE, and major bleeding were 0.4%, 4.6%, and 24%, respectively. On multivariable analyses, initial PE presentation (hazard ratio [HR], 3.03; 95% CI, 2.49-3.69), dementia (HR, 1.47; 95% CI, 1.01-2.13), and anemia (HR, 0.72; 95% CI, 0.57-0.91) predicted recurrent PE, whereas older age (HR, 2.11; 95% CI, 1.15-3.87), inflammatory bowel disease (HR, 4.39; 95% CI, 1.00-19.3), and anemia (HR, 2.24; 95% CI, 1.35-3.73) predicted major bleeding. Prognostic scores were formulated, with C statistics of 0.63 for recurrent PE and 0.69 for major bleeding.
Recurrent DVT and PE were frequent but had low CFRs (0.4% and 4.6%, respectively) after discontinuing anticoagulation. On the contrary, major bleeding was rare but had high CFR (24%). A few clinical factors may predict these outcomes.
对于首次无诱因静脉血栓栓塞症（VTE）患者，抗凝时间的长短应权衡 VTE 复发的可能性与大出血的风险。
分析至少接受 3 个月抗凝治疗后停止抗凝的首次无诱因 VTE 患者的复发性 VTE 和大出血的发生率和病死率（CFR）。
我们比较了 Registro Informatizado Enfermedad Trombo Embólica（RIETE）登记处和 Contemporary management and outcomes in patients with venous thromboembolism 登记处的患者的发生率和 CFR。我们使用逻辑回归模型来确定复发性肺栓塞（PE）和大出血的预测因素。
在 RIETE 登记处的 8261 例无诱因 VTE 患者中，4012 例（48.6%）为单纯深静脉血栓形成（DVT），4250 例为 PE。中位随访时间（318 天）显示 543 例 DVT 复发，540 例 PE 复发，71 例大出血，447 例死亡。 Contemporary management and outcomes in patients with venous thromboembolism 登记处的结果相似。复发性 DVT、PE 和大出血的相应 CFR 分别为 0.4%、4.6%和 24%。多变量分析显示，初始 PE 表现（危险比[HR]，3.03；95%CI，2.49-3.69）、痴呆（HR，1.47；95%CI，1.01-2.13）和贫血（HR，0.72；95%CI，0.57-0.91）预测 PE 复发，而年龄较大（HR，2.11；95%CI，1.15-3.87）、炎症性肠病（HR，4.39；95%CI，1.00-19.3）和贫血（HR，2.24；95%CI，1.35-3.73）预测大出血。制定了预测评分，PE 复发的 C 统计量为 0.63，大出血的 C 统计量为 0.69。
停止抗凝后，复发性 DVT 和 PE 较为常见，但 CFR 较低（分别为 0.4%和 4.6%）。相反，大出血罕见，但 CFR 较高（24%）。一些临床因素可能预测这些结果。
