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J Thromb Haemost:静脉血栓形成诊断时的D-二聚体水平与复发风险相关!

2017-05-30 xing.T MedSci原创

由此可见,VTE首次诊断时低血浆D-二聚体(≤1500ng/mL)与低复发风险相关,尤其是在DVT患者和无诱因事件患者中。该研究结果表明,避免长期抗凝治疗的临床决策可以考虑基于VTE首次诊断时的低D-二聚体水平。

静脉血栓栓塞症(VTE)是一种常见的疾病,复发率较高。停止抗凝治疗后测量D-二聚体可以预测复发,并可用于决定是否延长治疗。然而,在VTE首次诊断时测量的D-二聚体能否用于评估复发风险仍为未知。近日,血栓和凝血疾病权威杂志Journal of Thrombosis and Haemostasis上发表了一篇研究文章,研究人员旨在探讨在VTE首次诊断时测量的D-二聚体与复发性VTE发生风险之间的相关性。

研究人员收集了454例无肿瘤的首次VTE患者的临床危险因素和实验室指标,并记录了随访期间(1994年-2012年)发生的复发性VTEs和死亡。

在中位随访3.9年期间,84例患者发生了复发性静脉血栓栓塞。D-二聚体水平位于最低四分位数范围(≤1500ng/mL)的受试者粗略的复发率为1.7(95%可信区间[CI]为1-2.9)人每100人每年,D-二聚体水平位于最高四分位数范围的受试者复发率4.9(95%CI为3.9-6.1)人每100人每年,得到的绝对风险差异为3.2人每100人每年。血浆D-二聚体的≤1500 ng/mL的患者比D-二聚体>1500ng/mL的患者的复发风险要低54%(风险比为0.46;95%CI为0.25-0.82)。这一相关性在无诱因事件患者和深静脉血栓形成的患者中特别明显,在D-二聚体的≤1500 ng/mL的患者中复发风险分别降低了66%(风险比为0.34;95%CI为0.15-0.74)和68%(风险比为0.32;95%CI为0.14-0.71)。

由此可见,VTE首次诊断时低血浆D-二聚体(≤1500ng/mL)与低复发风险相关,尤其是在DVT患者和无诱因事件患者中。该研究结果表明,避免长期抗凝治疗的临床决策可以考虑基于VTE首次诊断时的低D-二聚体水平。

原始出处:

E. Bjøri,et al. D-dimer at venous thrombosis diagnosis is associated with risk of recurrence.Journal of Thrombosis and Haemostasis.2017. http://onlinelibrary.wiley.com/doi/10.1111/jth.13648/full

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    2017-11-24 xue8602
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    2018-05-08 fusion
  4. 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encryptionId=1066844469, topicName=HAE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Tue Apr 17 17:46:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950349, encodeId=2ad019503492f, 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=71, 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 Jan 23 13:46:00 CST 2018, time=2018-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205827, encodeId=18b920582e22, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRk75KAEKrLGic0S0IvH1aNynsEFQWiaNKdtzvtwj2kafCoPg2icYVbrfBCFiaS74X1uEiaaTTY1H9Xyem/0, createdBy=cec11614828, createdName=chunjianf, createdTime=Sat Jun 03 06:40:25 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483251, encodeId=c2961483251e5, content=<a href='/topic/show?id=c82e991e71b' target=_blank style='color:#2F92EE;'>#静脉血栓形成#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99177, encryptionId=c82e991e71b, topicName=静脉血栓形成)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d387907505, createdName=ms5187542471278033, createdTime=Thu Jun 01 14:46:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310840, encodeId=9890131084071, content=<a 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204660, encodeId=6930204660fc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 31 06:48:37 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2018-04-17 changfy
  5. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204660, encodeId=6930204660fc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 31 06:48:37 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2018-01-23 hxj0117
  6. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204660, encodeId=6930204660fc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 31 06:48:37 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-06-03 chunjianf

    学习了谢谢分享

    0

  7. 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1905467, encodeId=caf2190546e09, 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=73, 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=Mon Oct 02 17:46:00 CST 2017, time=2017-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955290, encodeId=53531955290a5, 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=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, 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  9. [GetPortalCommentsPageByObjectIdResponse(id=1905467, encodeId=caf2190546e09, 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=73, 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=Mon Oct 02 17:46:00 CST 2017, time=2017-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955290, encodeId=53531955290a5, 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=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204660, encodeId=6930204660fc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 31 06:48:37 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-05-31 清风拂面

    学习了,谢谢分享

    0

  10. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=204660, encodeId=6930204660fc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed May 31 06:48:37 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-05-31 龙胆草

    学习了,谢谢分享

    0

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J Am Acad Dermatol:天胞疮患者的静脉血栓栓塞风险如何?

天疱疮是一种自身免疫性粘膜皮肤病,用长期免疫抑制药物治疗。患有天疱疮的患者死亡率增加,有些队列引用静脉血栓栓塞(VTE)作为该群体的重大死因。VTE由肺栓塞(PE)和深静脉血栓形成(DVT)组成,是一个重要的公共卫生问题,主要发生于住院病人,并且是最常见的可预防的住院死因。但是目前对于天疱疮的VTE风险知之甚少。住院治疗患有天疱疮和大疱性类天疱疮共患的患者的VTE风险升高,但天疱疮患者的风险未知。

JAHA:抗抑郁药、抑郁症和静脉血栓栓塞风险!

由此可见,在英国妇女中抗抑郁药的使用是普遍存在的,并且与VTE的风险增加相关。

Eur Heart J:他汀类药物与静脉血栓栓塞的二级预防效果如何?

由此可见,观察性队列研究的证据显示他汀类药物对复发性VTE有益。需要精心设计的干预研究来证实这些发现。

Eur Heart J:银屑病关节炎、银屑病和类风湿关节炎患者静脉血栓栓塞的风险如何?

由此可见,虽然全身炎症是VTE的危险因素,与对照者相比,发生VTE的风险在三种不同的炎症性疾病:类风湿关节炎、PsA和牛皮癣的患者中是不同的。

J Thromb Haemost:VTE患者围手术期中断直接口服抗凝治疗血栓和出血结局如何?

在VTE患者中围手术期中断DOACs,使用考虑DOAC半衰期和潜在的手术出血风险的策略,似乎是安全和有效的。

JAHA:无诱因静脉血栓栓塞对死亡和主要心血管事件的长期影响如何?

由此可见,这项全国性的队列研究显示无诱因的静脉血栓栓塞的患者,尤其是老年糖尿病男性患者,死亡和心血管事件的风险增加。死亡和主要心血管不良事件的风险在确诊后的第一年内最高,并在后续10年的随访期间会一直持续。

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