Douketis J D, Kearon C, Bates S, Duku E K, Ginsberg J S
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JAMA. 1998 Feb 11;279(6):458-62. doi: 10.1001/jama.279.6.458.
The most serious complication of deep vein thrombosis (DVT) or nonfatal pulmonary embolism (PE) is fatal PE. However, reliable estimates as to the risk of fatal PE in patients with treated DVT or PE are lacking.
To provide reliable estimates of the risk of fatal PE and the case-fatality rate of recurrent DVT or PE among patients presenting with symptomatic DVT or PE, during and following 3 months of anticoagulant therapy.
A MEDLINE literature search was performed to identify prospective studies in which patients with symptomatic DVT or PE were treated with 5 to 10 days of heparin and 3 months of oral anticoagulants. We searched the years 1966 to September 1997 using the search terms thrombophlebitis, diagnosis, drug therapy, and prognosis. Current Contents and bibliographies were also scanned.
Of 137 retrieved studies, 25 studies satisfied predetermined methodologic criteria and were included in the analysis.
Among patients presenting with DVT, the rate of fatal PE during anticoagulant therapy was 0.4% (95% confidence interval [CI], 0.2%-0.6%); following anticoagulant therapy it was 0.3 per 100 patient-years (95% CI, 0.1-0.8). The case-fatality rate of recurrent DVT or PE during anticoagulant therapy was 8.8% (95% CI, 5.0%-14.1%); following anticoagulant therapy it was 5.1% (95% CI, 1.4%-12.5%). Among patients presenting with PE, the rate of fatal PE during anticoagulant therapy was 1.5% (95% CI, 0.9%-2.2%); following anticoagulant therapy it was 0 per 265 patient-years (95% CI, 0-3.6). The case-fatality rate of recurrent DVT or PE among patients presenting with PE was 26.4% (95% CI, 16.7%-38.1%).
Among patients with symptomatic PE or DVT who are treated with anticoagulants for 3 months, fatal PE is rare during and following anticoagulant therapy. Patients presenting with PE are more likely to die of recurrent PE or DVT than are patients presenting with DVT.
深静脉血栓形成（DVT）或非致死性肺栓塞（PE）最严重的并发症是致死性PE。然而，对于接受治疗的DVT或PE患者发生致死性PE的风险，目前仍缺乏可靠的评估。
提供有症状DVT或PE患者在抗凝治疗期间及治疗后3个月内发生致死性PE的风险以及复发性DVT或PE病死率的可靠评估。
进行MEDLINE文献检索，以确定对有症状DVT或PE患者采用肝素治疗5至10天及口服抗凝剂治疗3个月的前瞻性研究。我们使用搜索词“血栓性静脉炎”、“诊断”、“药物治疗”和“预后”检索了1966年至1997年9月的文献。还浏览了《现刊目次》和参考文献目录。
在检索到的137项研究中，25项研究符合预定的方法学标准并纳入分析。
在患有DVT的患者中，抗凝治疗期间致死性PE的发生率为0.4%（95%可信区间[CI]，0.2%-0.6%）；抗凝治疗后为每100患者年0.3例（95%CI，0.1-0.8）。抗凝治疗期间复发性DVT或PE的病死率为8.8%（95%CI，5.0%-14.1%）；抗凝治疗后为5.1%（95%CI，1.4%-12.5%）。在患有PE的患者中，抗凝治疗期间致死性PE的发生率为1.5%（95%CI，0.9%-2.2%）；抗凝治疗后为每265患者年0例（95%CI，0-3.6）。患有PE的患者中复发性DVT或PE的病死率为26.4%（95%CI，16.7%-38.1%）。
在接受抗凝治疗3个月的有症状PE或DVT患者中，抗凝治疗期间及治疗后致死性PE罕见。与患有DVT的患者相比，患有PE的患者死于复发性PE或DVT的可能性更大。
