在怀疑复发性静脉血栓栓塞的患者中执行临床决策规则:多中心前性队列研究
Vicky Mai1, Emily S L Martens2, Marc Righini3
1Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Journal of thrombosis and haemostasis : JTH
|June 27, 2025
概括
使用临床决策规则 (CDR) 诊断复发性静脉血栓塞栓症 (VTE) 的效率低于第一次VTE. 这些规则有助于分层风险,但在没有成像的情况下排除VTE复发的可能性较低.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 临床决策 临床决策
背景情况:
- 在以前患有静脉血栓塞栓症的患者中诊断静脉血栓塞栓症 (VTE) 是具有挑战性的.
- 现有的临床决策规则 (CDR) 在这个特定的患者群体中没有得到充分的研究.
- 与首次VTE诊断相比,目前排除VTE复发而不需要成像的方法效率较低.
研究的目的:
- 评估已建立的CDRs的性能,特别是威尔斯和日内瓦得分,在疑似VTE复发的患者中.
- 在这个队列中评估D-二分体测试的诊断产量.
- 为了比较复发性VTE与首次VTE诊断的CDR的安全性和效率.
主要方法:
- 进行了一项国际,前性,多中心观察队列研究.
- 从2014年11月到2019年1月,在8个地点注册了怀疑VTE复发的门诊患者.
- 主要结局是CDR的表现,次要结局包括D-二次元产量和在3个月的随访期间判断疑似复发性VTE.
主要成果:
- 在疑似孤立深静脉血栓形成症 (DVT) 的患者中,VTE复发率随着概率组的增加而增加 (低:6.0%,中度:21.0%,高:43.9%).
- 同样,对于疑似孤立的肺栓塞,复发率因概率组而异 (低:13.3%,中度:35.0%,高:48.0%).
- 在阴性D-二次体患者中,复发性静脉动脉瘤被诊断为3.1%的疑似孤立的DVT和0.0%的疑似肺栓塞±DVT.
结论:
- CDRs有效地描述了患有越来越多VTE复发的患者.
- 然而,在没有成像检查的情况下排除复发性VTE的效率和安全性被发现低于怀疑VTE第一个发作的患者.
- 这项研究强调了需要仔细考虑VTE病史患者的CDR和诊断策略.
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