中国普外基础与临床杂志

中国普外基础与临床杂志

老年人静脉血栓栓塞症的研究进展

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目的 总结现阶段老年人静脉血栓栓塞症的研究进展。 方法 复习近年来国内外有关老年人静脉血栓栓塞症的流行病学、危险因素、诊断、防治及预后方面的文献并进行综述。 结果 静脉血栓栓塞症对于老年人来说是较为常见的一类心血管系统疾病,其发生率较高,但老年人的预防程度重视不够,其临床表现无年轻人明显。对老年人静脉血栓栓塞症,各种检查手段各有其优缺点,治疗以抗凝为主,但需注意出血风险。 结论 老年人静脉血栓栓塞症的发病率高,诊断措施多样,需要分类对待,治疗过程中的利弊尤其需要注意,加强其专门的研究更有必要。

Objective To summary the present research progress of venous thromboembolism in the elderly. Methods Reviewed the literatures in recent years about the epidemiology, risk factors, diagnosis and prevention, prognosis of venous thromboembolism in the elderlies. Results Venous thromboembolism was a more common of cardiovascular system diseases for the elderly, the incidence was higher, but the elderlies didn’t pay much attention on it. The clinical manifestations of VTE in elderlies were different from young people, and all kinds of inspection methods had advantages and disadvantages. It gave priority to anticoagulation therapy, but we should pay attention to the risk of bleeding. Conclusion High incidence of venous thromboembolism was observed in the elderlies, and diagnostic measures for venous thromboembolism were varuous. In the process of treatment, classification, the pros and cons were especially needed to pay attention to, and its special researches were necessary.

关键词: 静脉血栓栓塞; 老年人; 防治; 预后

Key words: venous thromboembolism; elderly; prevention and treatment; prognosis

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1. Naess IA, Christiansen SC, Romundstad P, et al. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost, 2007, 5(4): 692-699.
2. Spencer FA, Gore JM, Lessard D, et al. Venous thromboembolism in the elderly. A community-based perspective. Thromb Haemost, 2008, 100(5): 780-788.
3. Tagalakis V, Patenaude V, Kahn SR, et al. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med, 2013, 126(9): 832.
4. Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med, 2000, 160(6): 761-768.
5. LaMori JC, Shoheiber O, Mody SH, et al. Inpatient resource use and cost burden of deep vein thrombosis and pulmonary embolism in the United States. Clin Ther, 2015, 37(1): 62-70.
6. Silverstein RL, Bauer KA, Cushman M, et al. Venous thrombosis in the elderly: more questions than answers. Blood, 2007, 110(9): 3097-3101.
7. Link RP. National heart, lung, and blood institute programs for deep vein thrombosis. Arterioscler Thromb Vasc Biol, 2008, 28(3): 392-393.
8. Méan M, Righini M, Jaeger K, et al. The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology. J Thromb Thrombolysis, 2013, 36(4): 475-483.
9. Poli D, Antonucci E, Testa S, et al. Bleeding risk in very old patients on vitamin K antagonist treatment: results of a prospective collaborative study on elderly patients followed by Italian Centres for Anticoagulation. Circulation, 2011, 124(7): 824-829.
10. Spencer FA, Gurwitz JH, Schulman S, et al. Venous thromboembolism in older adults: a community-based study. Am J Med, 2014, 127(6): 530-537.
11. López-Jiménez L, Montero M, González-Fajardo JA, et al. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica, 2006, 91(8): 1046-1051.
12. Folsom AR, Boland LL, Cushman M, et al. Frailty and risk of venous thromboembolism in older adults. J Gerontol A Biol Sci Med Sci, 2007, 62(1): 79-82.
13. Ageno W, Agnelli G, Imberti D, et al. Risk factors for venous thromboembolism in the elderly: results of the master registry. Blood Coagul Fibrinolysis, 2008, 19(7): 663-667.
14. Di Minno G, Mannucci PM, Tufano A, et al. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism. J Thromb Haemost, 2005, 3(7): 1459-1466.
15. Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost, 2010, 8(10): 2105-2112.
16. Mohebali D, Kaplan D, Carlisle M, et al. Alterations in platelet function during aging: clinical correlations with thromboinflammatory disease in older adults. J Am Geriatr Soc, 2014, 62(3): 529-535.
17. Kucher N, Leizorovicz A, Vaitkus PT, et al. Efficacy and safety of fixed low-dose dalteparin in preventing venous thromboembolism among obese or elderly hospitalized patients: a subgroup analysis of the PREVENT trial. Arch Intern Med, 2005, 165(3): 341-345.
18. Alikhan R, Cohen AT, Combe S, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med, 2004, 164(9): 963-968.
19. Greig MF, Rochow SB, Crilly MA, et al. Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients: where is the evidence? Age Ageing, 2013, 42(4): 428-434.
20. Decousus H, Tapson VF, Bergmann JF, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest, 2011, 139(1): 69-79.
21. Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med, 1999, 341(11): 793-800.
22. Leizorovicz A, Cohen AT, Turpie AG, et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation, 2004, 110(7): 874-879.
23. Cohen AT, Davidson BL, Gallus AS, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ, 2006, 332(7537): 325-329.
24. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e195S-e226S.
25. Le Gal G, Righini M, Roy PM, et al. Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age. J Thromb Haemost, 2005, 3(11): 2457-2464.
26. Bajaj N, Bozarth AL, Guillot J, et al. Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data. J Thromb Thrombolysis, 2014, 37(3): 287-292.
27. Piazza G, Seddighzadeh A, Goldhaber SZ. Deep-vein thrombosis in the elderly. Clin Appl Thromb Hemost, 2008, 14(4): 393-398.
28. Oger E, Bressollette L, Nonent M, et al. High prevalence of asymptomatic deep vein thrombosis on admission in a medical unit among elderly patients. Thromb Haemost, 2002, 88(4): 592-597.
29. Siccama RN, Janssen KJ, Verheijden NA, et al. Systematic review: diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly. Ageing Res Rev, 2011, 10(2): 304-313.
30. Righini M, Le Gal G, Perrier A, et al. Effect of age on the assessment of clinical probability of pulmonary embolism by prediction rules. J Thromb Haemost, 2004, 2(7): 1206-1208.
31. Di Nisio M, Squizzato A, Rutjes AW, et al. Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review. J Thromb Haemost, 2007, 5(2): 296-304.
32. Lucassen W, Geersing GJ, Erkens PM, et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med, 2011, 155(7): 448-460.
33. Geersing GJ, Zuithoff NP, Kearon C, et al. Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis. BMJ, 2014, 348: g1340.
34. Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e351S-e418S.
35. Righini M, Goehring C, Bounameaux H, et al. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med, 2000, 109(5): 357-361.
36. Eichinger S, Heinze G, Kyrle PA. D-dimer levels over time and the risk of recurrent venous thromboembolism: an update of the Vienna prediction model. J Am Heart Assoc, 2014, 3(1): e000467.
37. Tritschler T, Méan M, Limacher A, et al. Predicting recurrence after unprovoked venous thromboembolism: prospective validation of the updated Vienna Prediction Model. Blood, 2015, 126(16): 1949-1951.
38. Castellucci LA, Cameron C, Le Gal G, et al. Clinical and safety outcomes associated with treatment of acute venous thromboembolism: a systematic review and meta-analysis. JAMA, 2014, 312(11): 1122-1135.
39. Chai-Adisaksopha C, Crowther M, Isayama T, et al. The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood, 2014, 124(15): 2450-2458.
40. MacLean S, Mulla S, Akl EA, et al. Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e1S-e23S.
41. Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA, 2014, 311(11): 1117-1124.
42. Howard LS, Huqhes RJ. National institute for health and clinical excellence, venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. London: Oxford, 2012: 235-246.
43. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069.
44. 作者?. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012, 2 (Suppl): 1-138.
45. Gasparini A, Evans M, Coresh J, et al. Prevalence and recognition of chronic kidney disease in Stockholm healthcare. Nephrol Dial Transplant, 2016, 31(12): 2086-2094.
46. Coresh J, Astor BC, Greene T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis, 2003, 41(1): 1-12.
47. Kooiman J, Sijpkens YW, van Buren M, et al. Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography. J Thromb Haemost, 2014, 12(10): 1658-1666.
48. Ikesaka R, Carrier M. Clinical significance and management of subsegmental pulmonary embolism. J Thromb Thrombolysis, 2015, 39(3): 311-314.
49. Di Minno MN, Ambrosino P, Dentali F. Safety of warfarin in " high-risk” populations: a meta-analysis of randomized and controlled trials. Thromb Res, 2017, 150: 1-7.
50. van Es N, Coppens M, Schulman S, et al. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood, 2014, 124(12): 1968-1975.
51. Bajc M, Neilly JB, Miniati M, et al. EANM guidelines for ventilation/perfusion scintigraphy: part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. Eur J Nucl Med Mol Imaging, 2009, 36(8): 1356-1370.
52. Levi M, Hovingh GK, Cannegieter SC, et al. Bleeding in patients receiving vitamin K antagonists who would have been excluded from trials on which the indication for anticoagulation was based. Blood, 2008, 111(9): 4471-4476.
53. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.
54. Aujesky D, Smith KJ, Roberts MS. Oral anticoagulation strategies after a first idiopathic venous thromboembolic event. Am J Med, 2005, 118(6): 625-635.
55. Poli D, Antonucci E, Testa S, et al. The predictive ability of bleeding risk stratification models in very old patients on vitamin K antagonist treatment for venous thromboembolism: results of the prospective collaborative EPICA study. J Thromb Haemost, 2013, 11(6): 1053-1058.
56. Scherz N, Méan M, Limacher A, et al. Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism. J Thromb Haemost, 2013, 11(3): 435-443.
57. Leiss W, Méan M, Limacher A, et al. Polypharmacy is associated with an increased risk of bleeding in elderly patients with venous thromboembolism. J Gen Intern Med, 2015, 30(1): 17-24.
58. Frey PM, Méan M, Limacher A, et al. Physical activity and risk of bleeding in elderly patients taking anticoagulants. J Thromb Haemost, 2015, 13(2): 197-205.
59. Donzé J, Clair C, Hug B, et al. Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med, 2012, 125(8): 773-778.
60. Kämpfen P, Méan M, Limacher A, et al. Risk of falls and bleeding in elderly patients with acute venous thromboembolism. J Intern Med, 2014, 276(4): 378-386.
61. Klok FA, Dzikowska-Diduch O, Kostrubiec M, et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost, 2016, 14(1): 121-128.
62. Matthews DT, Hemnes AR. Current concepts in the pathogenesis of chronic thromboembolic pulmonary hypertension. Pulm Circ, 2016, 6(2): 145-154.
63. van Es J, den Exter PL, Kaptein AA, et al. Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL. Thromb Res, 2013, 132(5): 500-505.
64. Tavoly M, Utne KK, Jelsness-Jørgensen LP, et al. Health-related quality of life after pulmonary embolism: a cross-sectional study. BMJ Open, 2016, 6(11): e013086.
65. Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation, 2014, 130(18): 1636-1661.
66. Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation, 2014, 129(7): 764-772.
67. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med, 2010, 363(26): 2499-2510.
68. EINSTEIN-PE Investigators, Büller HR, Prins MH, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366(14): 1287-1297.
69. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med, 2013, 369(9): 799-808.
70. Hokusai-VTE Investigators, Büller HR, Décousus H, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med, 2013, 369(15): 1406-1415.