Monreal M, Urrutia A, Marti S, Cuxart A, Roncales J
Service of Internal Medicine and Hematology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Haemostasis. 1997 Mar-Apr;27(2):91-8. doi: 10.1159/000217439.
In a series of patients with pulmonary embolism (PE) we have previously demonstrated that the risk of recurrent PE was inversely correlated to platelet count (PlC) levels. To find out whether PlC levels were also associated to a different incidence of heparin-related bleeding complications, we report our experience with 1,103 consecutive patients with venous thromboembolism (VTE) receiving full-dose heparin therapy. Six points of clinical and laboratory information were recorded on admission and then compared to the development of bleeding: the patient's age and sex; the etiology of VTE; the type of heparin used (unfractioned, UFH, vs. low-molecular-weight, LMWH), the presence or lack of PE findings on lung scan, and the PC levels on admission. Bleeding occurred in 64/1,103 patients (6%). Patients who bled were significantly older than those who did not (72 +/- 11 vs. 64 +/- 17 years; p = 0.0005). There were no significant differences in bleeding rate according to any of the risk factors that could have predisposed to VTE, but patients treated with UFH bled significantly more frequently than those on LMWH (48/636 vs. 16/467; odds ratio: 2.30; 95% confidence interval: 1.25-4.28). Finally, mean PlC levels were significantly lower at VTE diagnosis in patients who subsequently bled (227 +/- 112 vs. 262 +/- 110 x 10(9) liters-1; p = 0.01). The logistic regression analysis confirmed that all three variables were independent risk factors for bleeding complications. This is the first study to demonstrate that PlC levels (within the normal range) are inversely correlated with the risk of heparin-related bleeding. These findings may be interest not only from the point of view of pathogenesis but also clinically, as they may be used in the decision as to which VTE patients could receive heparin therapy at home.
在一系列肺栓塞（PE）患者中，我们之前已经证明复发性PE的风险与血小板计数（PlC）水平呈负相关。为了弄清楚PlC水平是否也与肝素相关出血并发症的不同发生率有关，我们报告了1103例连续接受全剂量肝素治疗的静脉血栓栓塞症（VTE）患者的经验。入院时记录了六点临床和实验室信息，然后与出血情况进行比较：患者的年龄和性别；VTE的病因；使用的肝素类型（普通肝素，UFH，与低分子量肝素，LMWH），肺部扫描上有无PE表现，以及入院时的PC水平。1103例患者中有64例（6%）发生出血。出血患者明显比未出血患者年龄大（72±11岁对64±17岁；p = 0.0005）。根据任何可能导致VTE的危险因素，出血率均无显著差异，但接受UFH治疗的患者出血频率明显高于接受LMWH治疗的患者（48/636对16/467；比值比：2.30；95%置信区间：1.25 - 4.28）。最后，随后出血的患者在VTE诊断时的平均PlC水平显著较低（227±112对262±110×10⁹/升；p = 0.01）。逻辑回归分析证实这三个变量都是出血并发症的独立危险因素。这是第一项证明PlC水平（在正常范围内）与肝素相关出血风险呈负相关的研究。这些发现不仅从发病机制的角度可能有意义，而且在临床上也可能有意义，因为它们可用于决定哪些VTE患者可以在家接受肝素治疗。
