对上肢静脉血栓形成后肺栓塞、再次血栓栓塞和出血的发生率进行系统综述和荟萃分析。
A systematic review and meta-analysis of incidence of post-thrombotic syndrome, recurrent thromboembolism, and bleeding after upper extremity vein thrombosis.
发表日期：2023 Sep 15
作者：
Olivier Espitia, Alizée Raimbeau, Benjamin Planquette, Sandrine Katsahian, Olivier Sanchez, Benjamin Espinasse, Antoine Bénichou, Juliette Murris
来源：
J Vasc Surg-Venous L
摘要：
上肢静脉血栓形成（UEVT）的并发症数据有限且异质。本研究目的是评估UEVT患者中深静脉血栓栓塞症（VTE）复发、出血和血栓后综合征（PTS）的合并比例。根据Prisma指南，我们对PubMed、Embase和Cochrane图书馆数据库进行了系统的文献综述。所有包括UEVT患者的研究都是以英文发表的。对UEVT后的VTE复发、出血和PTS进行荟萃分析，计算出合并估计值和相关的95％的置信区间（CI）。根据与癌症相关的UEVT和导管相关的静脉血栓形成进行了亚组分析。排除了帕盖特施罗特综合征和努力性血栓形成的患者。共纳入了55项研究，涉及15,694名患者。VTE复发、大出血和PTS的合并比例分别为4.8% [95%CI 3.8;6.2]、3.0% [95%CI 2.2;4.0]和23.8% [95%CI 17.0;32.3]。使用直接口服抗凝药（DOACs）治疗的患者的VTE复发比例为2.7% [95%CI 1.6;4.6]，低分子肝素（LMWH）治疗的患者为1.7% [95%CI 0.8;3.7]，维生素K拮抗剂（VKA）治疗的患者为4.4% [95%CI 1.5;11.8]（p=0.36）；癌症患者中VTE复发的比例为6.3% [95%CI 4.3;9.1]，而无癌症患者中为3.1% [95%CI 2.1;4.6]（p=0.01）。DOACs治疗下的大出血比例为2.1% [95%CI 0.9;5.1]，LMWH治疗的患者为3.2% [95%CI 1.4;7.2]，VKA治疗的患者为3.4% [95%CI 1.4;8.4]（p=0.72）。DOACs治疗下PTS的比例为11.8% [95%CI 6.5; 20.6]，LMWH治疗的患者为27.9% [95%CI 20.9; 36.2]，VKA治疗的患者为24.5% [95%CI 17.6; 33.1]（p=0.02）。本研究表明UEVT与PTS和复发率显著相关。与其他抗凝药物相比，DOACs的治疗可能与较低的PTS率相关。版权所有 © 2023 Elsevier Inc.
Data on complications following upper extremity vein thrombosis (UEVT) are limited and heterogeneous.The aim of the study was to evaluate the pooled proportions of venous thromboembolic disease (VTE) recurrence, bleeding, and post-thrombotic syndrome (PTS) in patients with UEVT. A systematic literature review was conducted on PubMed, Embase, and the Cochrane Library databases from January 2000 to April 2023 according to Prisma guidelines. All studies included patients with UEVT and were published in English. Meta-analyses of VTE recurrence, occurrence of bleeding and of PTS after UEVT were performed to compute pooled estimates and associated 95% confidence interval (CI) levels. Subgroup analyses according to cancer-associated UEVT and catheter-associated venous thrombosis were conducted. Patients with Paget-Schroetter syndrome or effort thrombosis were excluded.A total of 55 studies comprising 15,694 patients were included. The pooled proportions for VTE recurrence, major bleeding and PTS were 4.8% [95%CI 3.8;6.2], 3.0% [95%CI 2.2;4.0] and 23.8% [95%CI 17.0;32.3] respectively. The pooled proportions of VTE recurrence were 2.7% [95%CI 1.6;4.6] for patients treated with direct oral anticoagulants (DOACs), 1.7% [95%CI 0.8;3.7] for patients treated with low molecular weight heparin (LMWH) and 4.4% [95%CI 1.5;11.8] for vitamin K antagonist (VKA) (p=0.36); 6.3% [95%CI 4.3;9.1] in cancer patients compared to 3.1% [95%CI 2.1;4.6] in patients without cancer (p=0.01). The pooled proportion of major bleeding under DOACs was 2.1% (95%CI 0.9;5.1), 3.2% (95%CI 1.4;7.2) for patients treated with LMWH and 3.4% (95%CI 1.4;8.4) for patients treated with VKA (p=0.72). The pooled proportion of PTS for patients treated with DOACs was 11.8% [95%CI 6.5; 20.6], 27.9% [95%CI 20.9; 36.2] for patients treated with LMWH and 24.5% [95%CI 17.6; 33.1] for patients treated with VKA (p=0.02).This study suggests that UEVT is associated with significant rates of PTS and recurrence. Treatment with DOACs may be associated with a lower PTS rates than with other anticoagulants.Copyright © 2023. Published by Elsevier Inc.