Atkārtotu venozu tromboemboliju riska faktori un mirstība Paula Stradiņa klīniskā universitātes slimnīcā
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Mērķi: Venozo tromboemboliju (VTE) rekurence pēc primāra notikuma ir nereti sastopama; tomēr, nav pieejami riska izvērtēšanas kritēriji kas būtu izmantojami klīniskajā praksē. Pētījuma mērķis ir izvērtēt VTE recidīvu riska faktorus, kā arī ārstēšanas ietekmi uz rekurences biežumu viena centra pacientu kohortā. Materiāli un Metodes: Prospektīvs kohortas pētījums iekļāva vienas slimnīcas pacientus ar radioloģiski apstiprinātu akūtu VTE no 2014 Jūnija līdz 2018 Jūnijam. Pacienti tika apsekoti vismaz vienu gadu vai arī līdz iestājās nāve. Statistikas analīze tika veikta ar IBM SPSS Statistics 23 un Stata 13. Rezultāti: Pētījuma laikā tika iekļauti 219 pacienti. Pulmonāra embolija ar vai bez dziļo vēnu trombozes (DVT) tika atrasta 95,9% (n=2010), izolēta DVT atrasta 4,1% (n=9) no pacientiem. Kopējais dokumentēto recidīvu skaits bija 13 (5,9%). Incidence bija 5,6 no 100 personu gadiem. Rekurenta VTE paredzēja ievērojami augstāku mirstību (hazard ratio (HR) 6,64 [95% CI 2,61-16,93]). Vienvarianta analīzē, aktīvi noritoša malignitāte tika saistīta ar augstāku rekurences biežumu (p = 0,036). "Competing-risks" regresijas modelis (nāve kā "competing risk"), aktīvs audzējs ("subdistribution hazard ratio" (SHR)
2.11 (95% CI 0.58–7.76)) neuzrādīja statistisku nozīmību VTE recidīvam. Antikoagulantu terapijas pārtraukšana kā arī terapijas ilgums (≤6 vai >6 mēneši), un medikamentu klase akūtā vai ilgtermiņa terapijā (parenterāla, K vitamīna antagonisti (VKA), tiešie orālie antikoagulanti (TOAK)) netika atrasta saistība ar rekurencēm (p > 0,05). Secinājumi: Pacientiem kas piedzīvoja VTE recidīvu bija 6,6 reizes lielāka mirstība nekā pacientiem bez VTE recidīva. Aktīvi noritošs onkoloģisks process nebija statistiski nozīmīgs riska faktors rekurencei, ņemot vērā esošo nāves risku. Antikoagulācijas terapijā izmantotās medikamentu klases kā arī terapijas ilgums neietekmēja recidīvu biežumu.
Background and objectives: Recurrence of venous thromboembolism (VTE) after a primary event is common; however, no sufficient risk scores have been widely introduced in clinical practice. The aim of this study was to assess the risk factors for VTE recurrences, as well as the effect of treatment strategies on the recurrence rate in a single-center patient cohort. Materials and Methods: The prospective cohort study included consecutive patients in a single center from June 2014 till June 2018 presenting with acute VTE confirmed by imaging tests. All patients were followed up for at least one year or till death. Statistical analyses were conducted using IBM SPSS Statistics 23 and Stata 13. Competing risk of death was considered. Results: A total of 219 eligible patients were identified during the study period. Pulmonary embolism with or without deep vein thrombosis (DVT) was present in 95.9% (n = 210), isolated DVT was present in 4.1% (n = 9) of patients. The total number of documented recurrences was 13 (5.9%). Incidence rate was 5.6 per 100 person-years. Recurrent VTE predicted significantly higher mortality rate (hazard ratio (HR) 6.64 [95% CI 2.61–16.93]). In univariate analysis, active cancer was associated with higher recurrence rate (p = 0.036). In competing-risks regression model (with death as the competing risk), active cancer (subdistribution hazard ratio (SHR) 2.11 (95% CI 0.58–7.76)) did not retain statistical significance for VTE recurrence. Discontinuation and duration of anticoagulant treatment (≤6 or >6 months), and drug class in acute or long-term therapy (parenteral, vitamin K antagonist (VKA), direct oral anticoagulant (DOAC)) were not associated with recurrences (p > 0.05). Conclusions: Patients who experienced recurrent VTE had 6.6-fold higher mortality rate than patients with no recurrences. The presence of active cancer was not a statistically significant risk factor for recurrence when taking into account the competing risk of death. Duration and drug class of anticoagulation did not seem to impact recurrence rate.
Background and objectives: Recurrence of venous thromboembolism (VTE) after a primary event is common; however, no sufficient risk scores have been widely introduced in clinical practice. The aim of this study was to assess the risk factors for VTE recurrences, as well as the effect of treatment strategies on the recurrence rate in a single-center patient cohort. Materials and Methods: The prospective cohort study included consecutive patients in a single center from June 2014 till June 2018 presenting with acute VTE confirmed by imaging tests. All patients were followed up for at least one year or till death. Statistical analyses were conducted using IBM SPSS Statistics 23 and Stata 13. Competing risk of death was considered. Results: A total of 219 eligible patients were identified during the study period. Pulmonary embolism with or without deep vein thrombosis (DVT) was present in 95.9% (n = 210), isolated DVT was present in 4.1% (n = 9) of patients. The total number of documented recurrences was 13 (5.9%). Incidence rate was 5.6 per 100 person-years. Recurrent VTE predicted significantly higher mortality rate (hazard ratio (HR) 6.64 [95% CI 2.61–16.93]). In univariate analysis, active cancer was associated with higher recurrence rate (p = 0.036). In competing-risks regression model (with death as the competing risk), active cancer (subdistribution hazard ratio (SHR) 2.11 (95% CI 0.58–7.76)) did not retain statistical significance for VTE recurrence. Discontinuation and duration of anticoagulant treatment (≤6 or >6 months), and drug class in acute or long-term therapy (parenteral, vitamin K antagonist (VKA), direct oral anticoagulant (DOAC)) were not associated with recurrences (p > 0.05). Conclusions: Patients who experienced recurrent VTE had 6.6-fold higher mortality rate than patients with no recurrences. The presence of active cancer was not a statistically significant risk factor for recurrence when taking into account the competing risk of death. Duration and drug class of anticoagulation did not seem to impact recurrence rate.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
venoza tromboembolija; pulmonāra embolija; rekurence; vēzis; antikoagulācija, venous thromboembolism; pulmonary embolism; recurrence; cancer; anticoagulation