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血栓性,臨床的要因,および再発性静脈血栓性イベント
Sverre C Christiansen1, Suzanne C Cannegieter, Ted Koster
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
JAMA
|May 19, 2005
まとめ
再発性トランボティックイベントは,男性やイディオパシー初期イベントを有する男性においてより一般的です. トロンボフィリア検査は,治療戦略に限られた影響を及ぼしており,抗凝固剤の決定に臨床的要因がより重要である.
科学分野:
- 心血管医学は,心臓血管医学である.
- 血液学 ヘマトロジ
- 臨床流行病学 臨床流行病学とは
背景:
- 静脈血栓性イベント (VTE) の再発率と,血栓性症などの危険因子の影響については議論されています.
- 予防策と抗凝固剤治療期間を導くための血栓性スクリーニングの臨床的有用性は不明である.
研究 の 目的:
- 第1回VTE後の血栓性イベントの再発率を決定する.
- トロンボフィルの異常,患者の人口統計,治療要因を含む再発の決定要因を特定する.
主な方法:
- 第1回客観的に確認された血栓性イベントを有する474人の連続した患者 (年齢18〜70歳) を対象とした前向きのフォローアップ研究 (Leiden Thrombophilia Study).
- 患者は平均7.3年間追跡され,血栓性リスク因子,性別,初期イベントタイプ,経口避妊薬の使用に基づいて再発的なイベントを評価した.
主要な成果:
- 全体的な再発率は1000患者年当たり25.9であったが,発生後最初の2年間で最も高い発生率であった.
- 男性は女性よりも2.7倍も再発リスクが高い. イディオパシー初期イベントは,より高い再発リスクをもたらした (HR,1.9).
- 女性における経口避妊薬の使用は,再発率を増加させた. 血栓性異常は,再発リスクとの関連が多様で,しばしば無意味であった (例えば,XI因子上昇HR 0.6;抗凝固剤欠乏HR 1.8).
結論:
- プロトロンボティック異常は,VTE再発リスクにおいて,限られた役割を果たしているようです.
- トロンボフィリアのスクリーニングは,現在の予防戦略に最小限の影響を及ぼします.
- 臨床的要因は,実験室の異常よりも,抗凝固療法期間を導く上でより重要である.
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