目的:探讨肿瘤患者静脉血栓栓塞症(VTE)后生存时间、导管(CRVTE)和非导管相关性VTE(NCRVTE)抗凝疗效和安全性的差异。
方法:进行了回顾性研究,和连续的癌症(消化系统,呼吸,泌尿生殖系统,血液和淋巴,和其他癌症)的VTE患者入选。抗凝治疗包括低分子量肝素(LMWH),华法林,新型直接口服抗凝剂(NDOACs),LMWH联合华法林,和LMWH结合NDOAC。从我院的电子病历数据库中收集数据,并通过Kruskal-WallisH检验进行相应的分析,卡方检验,费希尔的精确检验,Logistic回归,Kaplan-Meier分析,和考克斯回归。
结果:纳入263例患者,中位年龄(四分位距)为64岁(56-71岁),60.5%为男性.CRVTE组VTE复发率为16.7%,显著低于NCRVTE组的34.8%(P=.032)。心脏病与VTE复发独立相关(P=0.025)。CRVTE组在1、2和3年的Kaplan-Meier生存率估计为62.5%,60.0%,和47.5%,分别,与47.9%(P=0.130)相比,38.7%(P=.028),和30.1%(P=0.046),分别,对于NCRVTE组。Cox回归显示手术(P=0.003),抗凝治疗类型(P=.009),VTE类型(P=.006)和癌症类型(P=.039)是VTE后3年生存的独立预后因素。非大出血和大出血没有显着差异(P=0.417)。抗凝治疗类型与出血事件独立相关(P=0.030)。
结论:与NCRVTE相比,患有CRVTE的癌症患者可能具有更好的抗凝疗效和生存率,抗凝安全性似乎无显著差异。
OBJECTIVE: To investigate the differences in survival after venous thromboembolism (VTE) and anticoagulation efficacy and safety between catheter (CRVTE) and non-catheter-related VTE (NCRVTE) in cancer patients.
METHODS: A retrospective research was conducted, and consecutive cancer (digestive, respiratory, genitourinary, blood and lymphatic, and the other cancers) patients with VTE were enrolled. The anticoagulation therapies included low-molecular-weight heparin (LMWH), warfarin, new type of direct oral anticoagulants (NDOACs), LMWH combined with warfarin, and LMWH combined with NDOACs. Data were collected from the electronic medical record database of our hospital and were analyzed accordingly by Kruskal-Wallis H Test, Chi-square test, Fisher\'s exact test, Logistic regressions, Kaplan-Meier analysis, and Cox regressions.
RESULTS: 263 patients were included, median age in years (interquartile range) was 64(56-71) and 60.5% were male. VTE recurrence rate was 16.7% in CRVTE group which was significantly lower than 34.8% in NCRVTE group (P = .032). Heart diseases were independently associated with VTE recurrence (P = .025). Kaplan-Meier survival estimates at 1, 2, and 3 years for CRVTE group were 62.5%, 60.0%, and 47.5%, respectively, compared with 47.9% (P = .130), 38.7% (P = .028), and 30.1% (P = .046), respectively, for NCRVTE group. Cox regression showed surgery (P = .003), anticoagulation therapy types (P = .009), VTE types (P = .006) and cancer types (P = .039) were independent prognostic factors for 3-year survival after VTE. Nonmajor and major bleeding were not significantly different (P = .417). Anticoagulation therapy types were independently associated with the bleeding events (P = .030).
CONCLUSIONS: Cancer patients with CRVTE potentially have a better anticoagulation efficacy and survival compared to NCRVTE, and the anticoagulation safety seems no significant difference.