医学
血栓性
危险系数
入射(几何)
前瞻性队列研究
内科学
队列
队列研究
狼疮抗凝剂
累积发病率
比例危险模型
外科
置信区间
血栓形成
光学
物理
作者
Trevor Baglin,Roger Luddington,Karen Brown,C. Baglin
出处
期刊:The Lancet
[Elsevier]
日期:2003-08-01
卷期号:362 (9383): 523-526
被引量:653
标识
DOI:10.1016/s0140-6736(03)14111-6
摘要
Stratification for risk of recurrence after a first episode of venous thromboembolism (VTE) would affect the duration of anticoagulant therapy. We aimed to determine the incidence of recurrence of VTE in relation to clinical risk factors and standard laboratory testing for heritable thrombophilic defects.We established a database to prospectively follow-up a cohort of unselected patients who had had a first episode of objectively proven VTE. We excluded patients with malignant disease and antiphospholipid syndrome. All patients were offered testing for heritable thrombophilia.At 2 years, the cumulative recurrence rate in 570 patients was 11%. Incidence was lowest after surgery-related VTE (0%) and highest after unprecipitated VTE (19.4%) (p<0.001). 85% of patients were tested for heritable thrombophilic defects. Recurrence rates were not related to presence or absence of laboratory evidence of heritable thrombophilia (hazard ratio 1.50 [95% CI 0.82-2.77]; p=0.187). In patients with a first event that was unprecipitated or was associated with a non-surgical trigger, recurrence rates did not differ in patients with or without thrombophilia (1.34 [0.73-2.46]; p=0.351).In unselected patients who have had a first episode of VTE, testing for heritable thrombophilia does not allow prediction of recurrent VTE in the first 2 years after anticoagulant therapy is stopped. However, assessment of clinical risk factors associated with the first episode of VTE does predict risk of recurrence. Patients with postoperative VTE have a very low rate of recurrence.
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