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Trombosis recurrente y supervivencia después de una primera trombosis venosa de la extremidad superior
L E Flinterman1, A van Hylckama Vlieg, F R Rosendaal
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Circulation
|September 10, 2008
Resumen
La primera trombosis venosa de las extremidades superiores (TUEV) conlleva un alto riesgo de recurrencia, especialmente para las mujeres y aquellas con un IMC superior a 25. Los pacientes con UEVT enfrentan tasas de supervivencia reducidas.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Hematología Hematología.
- Investigación de la trombosis.
Sus antecedentes:
- Comprensión limitada de los resultados después de la primera trombosis venosa de la extremidad superior (TUEV).
- Necesidad de datos sobre los factores de riesgo de incidencia, supervivencia y recurrencia en pacientes con TUEV.
Objetivo del estudio:
- Investigar la incidencia, las tasas de supervivencia y los factores de riesgo de recurrencia después de una primera TUEV.
- Para evaluar el pronóstico a largo plazo de los pacientes que experimentan UEVT.
Principales métodos:
- Estudio prospectivo de seguimiento de 224 pacientes (18-70 años) con una primera TUEV.
- Recopilación de datos a través de clínicas de anticoagulación, registro nacional de defunciones, registros médicos y cuestionarios.
- La duración media del seguimiento fue de 3 años.
Principales resultados:
- Alta incidencia de recurrencia (43,2 por cada 1000 personas-años) durante 3 años.
- Significativamente reducida la supervivencia: 5,4 veces mayor mortalidad que la población general.
- Aumento del riesgo de recurrencia observado en mujeres (HR 1.8) y pacientes con IMC >= 25 kg/m2).
- El uso del catéter venoso central en la trombosis inicial se asocia con un riesgo reducido de recurrencia.
- La trombosis no subclavia aumentó el riesgo de recurrencia; las mutaciones protrombóticas no lo hicieron.
Conclusiones:
- La primera UEVT está asociada con un mal pronóstico vital y un alto riesgo de recurrencia.
- Los principales factores de riesgo para la recurrencia incluyen el sexo femenino, el IMC elevado y la trombosis no subclávia.
- Investigaciones adicionales pueden informar estrategias de prevención y gestión específicas para la UEVT.
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