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J INTERN MED:静脉血栓栓塞后D-二聚体水平和复发风险

2019-08-13 xing.T MedSci原创

由此可见,停止抗凝治疗d-二聚体水平升高的VTE患者复发风险增加。

继发于暂时性危险因素的静脉血栓栓塞(VTE)患者可能在停止抗凝后发生VTE复发。识别有风险的患者可以帮助指导治疗的持续时间。近日,内科学领域权威杂志Journal of Internal Medicine上发表一篇研究文章,研究人员使用RIETE数据库评估停止抗凝治疗后d-二聚体检测的预后价值,以确定复发风险增加的患者。

暂时性危险因素分为主要危险因素(术后)或轻微危险因素(妊娠、雌激素使用、固定或近期旅行)。在2018年12月,1655例具有短暂危险因素的VTE患者(主要危险因素460例,轻微危险因素1195例)在停止抗凝治疗后接受了D-二聚体检查。

在具有主要危险因素的患者中,d-二聚体水平升高者复发率为:每100患者每年复发人数为5.74(95%CI为3.19-9.57),d-二聚体水平正常者复发率为2.68(95%CI为1.45-4.56)。在具有轻微危险因素的患者中,比率分别为:7.79(95%CI为5.71-10.4)和3.34(95%CI为2.39-4.53)。具有主要危险因素和d-二聚体水平升高(n=171)的患者的复发率(风险比[HR]:2.14; 95%CI为0.96-4.79)与正常水平的患者相比没有显著升高。具有轻微危险因素和d-二聚体水平升高(n=382)的患者复发率(HR为2.34; 95%CI为1.51-3.63)高于正常水平患者。在多变量分析中,升高的d-二聚体(HR为1.74; 95%CI为1.09-2.77)与轻微危险因素患者的复发风险增加相关,而与具有主要危险因素的患者无关。

由此可见,停止抗凝治疗d-二聚体水平升高的VTE患者复发风险增加。 

原始出处:

Orly Avnery,et al.D‐dimer levels and risk of recurrence following provoked venous thromboembolism: Findings from the RIETE registry.J INTERN MED. 2019.https://onlinelibrary.wiley.com/doi/10.1111/joim.12969

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    2020-03-10 hxj0117
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    2020-03-15 仁医06
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1905532, encodeId=b73c19055329c, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Fri Dec 13 07:48:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950377, encodeId=baa419503e79e, content=<a href='/topic/show?id=bfc624041dc' target=_blank style='color:#2F92EE;'>#二聚体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24041, encryptionId=bfc624041dc, topicName=二聚体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac59108, createdName=hxj0117, createdTime=Tue Mar 10 23:48:00 CST 2020, time=2020-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955446, encodeId=17981955446f4, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sun Dec 15 17:48:00 CST 2019, time=2019-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697954, encodeId=cecb169e95401, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sun Mar 15 20:48:00 CST 2020, time=2020-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310859, encodeId=e5161310859f6, content=<a href='/topic/show?id=b15c5628e9' target=_blank style='color:#2F92EE;'>#D-二聚体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5628, encryptionId=b15c5628e9, topicName=D-二聚体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e093393, createdName=luwei00, createdTime=Wed Aug 14 22:48:00 CST 2019, time=2019-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1609937, encodeId=7051160993e11, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Aug 14 22:48:00 CST 2019, time=2019-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371201, encodeId=d3233e120194, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Tue Aug 13 10:13:19 CST 2019, time=2019-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371195, encodeId=9e0c3e1195b1, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Tue Aug 13 08:02:55 CST 2019, time=2019-08-13, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1905532, encodeId=b73c19055329c, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Fri Dec 13 07:48:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950377, encodeId=baa419503e79e, content=<a href='/topic/show?id=bfc624041dc' target=_blank style='color:#2F92EE;'>#二聚体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24041, encryptionId=bfc624041dc, topicName=二聚体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac59108, createdName=hxj0117, createdTime=Tue Mar 10 23:48:00 CST 2020, time=2020-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955446, encodeId=17981955446f4, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sun Dec 15 17:48:00 CST 2019, time=2019-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697954, encodeId=cecb169e95401, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sun Mar 15 20:48:00 CST 2020, time=2020-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310859, encodeId=e5161310859f6, content=<a href='/topic/show?id=b15c5628e9' target=_blank style='color:#2F92EE;'>#D-二聚体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5628, encryptionId=b15c5628e9, topicName=D-二聚体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e093393, createdName=luwei00, createdTime=Wed Aug 14 22:48:00 CST 2019, time=2019-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1609937, encodeId=7051160993e11, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Aug 14 22:48:00 CST 2019, time=2019-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371201, encodeId=d3233e120194, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Tue Aug 13 10:13:19 CST 2019, time=2019-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371195, encodeId=9e0c3e1195b1, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Tue Aug 13 08:02:55 CST 2019, time=2019-08-13, status=1, ipAttribution=)]
    2019-08-13 phoebeyan520

    学习了

    0

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    2019-08-13 飛歌

    学习了很有用不错

    0

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J Thromb Haemost:孕妇产后静脉血栓栓塞危险因素患病率分析

由此可见,该研究表明产后妇女VTE危险因素的患病率较高。产后VTE风险具有个体化且较为复杂。

J Thromb Haemost:静脉血栓栓塞的癌症患者接受艾多沙班延长治疗的疗效

由此可见,在接受超过6个月的延长抗凝治疗的活动性癌症患者中,复发性VTE或大出血的发生率相对较低。口服艾多沙班的延长治疗似乎与皮下注射达肝素一样有效和安全。

2019年国际血栓和止血学会:强生宣布抗凝剂Xarelto在儿科静脉血栓栓塞III期临床取得成功

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由此可见,该研究结果表明低血浆MBL水平与VTE风险降低有关,特别是DVT风险降低。

J Thromb Haemost:依诺肝素预防妊娠相关静脉血栓栓塞的有效性和安全性

由此可见,在该队列中使用标准剂量依诺肝素进行血栓预防可有效预防PA-VTE。在分娩和分娩期间经常使用椎管内镇痛/麻醉,并且使用较高剂量的依诺肝素可能阻碍了该途径。产后出血很常见,较高剂量的血栓预防可能会增加产科出血并发症。这些数据并未表明在临床环境中需要考虑更高剂量的依诺肝素用于血栓预防。

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