延展期抗凝和标准抗凝治疗特发性静脉血栓栓塞性疾病疗效对比  

Comparative analysis of efficacy of prolonged anticoagulation therapy and conventional anticoagulation therapy for idiopathic venous thromboembolism

作　　者：韩静 常延河[1] 刘运秋[1] 刘晓宇[1] HAN Jing;CHANG Yanhe;LIU Yunqiu;LIU Xiaoyu(Kailuan General Hospital,Tangshan 063000,China)

机构地区：[1]开滦总医院,河北唐山063000

出　　处：《实用医学杂志》2023年第13期1663-1668,共6页The Journal of Practical Medicine

基　　金：中国煤炭工业协会2014年度科学技术研究指导性计划项目(编号:MTKJ2014⁃299)。

摘　　要：目的探讨延展期抗凝是否可以降低特发性静脉血栓栓塞症(VTE)结局事件的发生率。方法收集2013年1月1日至2016年12月31日在开滦总医院确诊为特发性VTE的患者306例,均已完成抗凝3个月,年龄24~85岁,随机分为标准抗凝组和延展期抗凝组进行治疗,共随访36个月,主要结局事件为VTE首次复发,次要结局事件为大出血及临床相关非大出血。结果共306例VTE患者纳入分析,年龄(61.54±11.54)岁,男性184例(60.13%)。标准抗凝组(n=155)VTE复发45例,大出血3例,临床相关非大出血21例;延展期抗凝组(n=151)VTE复发8例,大出血5例,临床相关非大出血30例。延展期抗凝治疗较标准治疗能显著降低VTE复发的发生率(log⁃rank检验,P<0.0001),未发现延展期抗凝治疗增加大出血和临床相关非大出血的发生率(log⁃rank检验,所有P=0.4588)。与标准抗凝治疗相比,延展期抗凝治疗能显著降低VTE复发的风险(HR=0.44,95%CI:0.19~0.99)。延展期抗凝治疗未增加VTE大出血和临床相关非大出血的风险,HR(95%CI)分别为1.00(0.24,4.19)、1.71(0.83,3.51)。结论行延展期抗凝治者VTE患者复发率低于行标准抗凝治者,大出血和临床相关非大出血发生率较行标准抗凝治者并未增加,延展期抗凝治疗对于预防特发性VTE患者复发有较高应用价值。Objective Idiopathic venous thromboembolism(VTE)has high prevalence,risk and recur⁃rence.The purpose of this study was to investigate whether prolonged anticoagulation can reduce the incidence of VTE outcome events.Methods We selected 306 patients diagnosed with idiopathic VTE in Kailuan General Hos⁃pital,from January 1,2013 to December 31,2016.All the patients(aged 24 to 85 years)with anticoagulation for 3 months were randomly divided into conventional anticoagulant group and prolonged anticoagulant group with a follow⁃up of36 months.The primary outcome event was the recurrence of VTE and secondary outcome events were bleed⁃ing,including major bleeding and clinically related non⁃major bleeding.Results A total of 306 VTE patients were included in the analysis,with a mean age of(61.54±11.54)years and 184 males(60.13%).In the conven⁃tional anticoagulation group(n=155),there were 45 VTE recurrence,3 major bleeding,and 21 clinically relevant non⁃major bleeding;in the prolonged anticoagulation group(n=151),there were 8 VTE recurrence,5 major bleeding and 30 clinically relevant non⁃major bleeding.Prolonged anticoagulation therapy significantly reduced the incidence of VTE recurrence when compared with conventional anticoagulation therapy(log⁃rank test,P<0.0001),and no significant increase of major bleeding and clinically relevant non⁃major bleeding(log⁃rank test,all P=0.4588)were observed.Prolonged anticoagulation therapy significantly reduced the risk of VTE recurrence com⁃pared to conventional anticoagulation therapy(HR=0.44,95%CI:0.19~0.99).Moreover,prolonged anticoagula⁃tion therapy didn′t increase the risk of major bleeding and clinically relevant non⁃major bleeding in VTE,with HR(95%CI)of 1.00(0.24,4.19),1.71(0.83,3.51),respectively.Conclusion The recurrence rate of VTE patients in the prolonged anticoagulant group is lower than that in the conventional anticoagulant group,and the incidence of major hemorrhage and clinically related non⁃major hemorrhage donot increase.The prolonge

关 键 词：静脉血栓栓塞症 抗凝治疗 复发 出血 

分 类 号：R563.5[医药卫生—呼吸系统]