RESUMEN
Data on the long-term survival following venous thromboembolism (VTE) are rare, and the influence of thrombophilia has not been evaluated thus far. Our aim was to assess thrombophilia-parameters as predictors for long-term survival of patients with VTE. Overall, 1,905 out-patients (99 with antithrombin-, protein C or protein S deficiency, 517 with factor V Leiden, 381 with elevated factor VIII and 160 with elevated homocysteine levels, of these 202 had a combination and 961 had none of these risk factors) were included in the study between September 1, 1994 and December 31, 2007. Retrospective survival analysis showed that a total of 78 patients (4.1%) had died during the analysis period, among those four of definite or possible pulmonary embolism and four of bleeding. In multivariable analysis including age and sex an association with increased mortality was found for hyperhomocysteinemia (hazard ratio 2.0 [1.1.-3.5]) whereas this was not the case for all other investigated parameters. We conclude that the classical hereditary thrombophilia risk factors did not have an impact on the long-term survival of patients with a history of VTE. Thus our study supports the current concept that thrombophilia should not be a determinant for decision on long term anticoagulation. However, hyperhomocysteinaemia, known as a risk factor for recurrent VTE and arterial disease, might impact survival.
Asunto(s)
Sobrevivientes/estadística & datos numéricos , Trombofilia/mortalidad , Tromboembolia Venosa/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antitrombinas/sangre , Austria/epidemiología , Biomarcadores/sangre , Causas de Muerte , Factor V/genética , Factor VIII/análisis , Femenino , Predisposición Genética a la Enfermedad , Humanos , Hiperhomocisteinemia/sangre , Hiperhomocisteinemia/mortalidad , Estimación de Kaplan-Meier , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Deficiencia de Proteína C/sangre , Deficiencia de Proteína C/mortalidad , Deficiencia de Proteína S/sangre , Deficiencia de Proteína S/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Trombofilia/sangre , Trombofilia/genética , Factores de Tiempo , Tromboembolia Venosa/sangre , Tromboembolia Venosa/genética , Adulto JovenRESUMEN
Limited data are available regarding long-term survival following venous thromboembolism (VTE). The objectives of this study are to evaluate long-term survival by retrospective survival analysis in patients with a history of VTE and to compare their survival with that of the general population. Patients with a history of VTE (min. 3 months after VTE) without cancer, who were referred to our department between 1994 and 2007, were included in the analysis. Information concerning mortality was available through the Austrian Central Death Register. The survival of patients was compared with that of the age- and gender-matched general Austrian population. Three thousand two hundred-nine patients (mean age, 46.2; range, 14-89 years) were included. Median time interval between the first VTE and inclusion was 14 months; median observation period was 6.6 years. During the considered time period, 169 patients (5.3%) died. The cumulative survival in patients was 0.97 and 0.87 after 5 and 10 years; men had a higher death rate than women; patients with idiopathic VTE had a less favourable survival than those with a triggering event. When patients were compared to the general population, the cumulative relative survival was 1.02 (95% CI 1.00-1.03). In none of the analysed subgroups (different sites of VTE; idiopathic vs. secondary VTE) was a reduced cumulative relative survival found. The relative survival of male patients was even slightly better, whereas that of women equalled that of the normal population. Our results indicate that after the initial phase, VTE does not seem to impair long-term survival of patients with a history of VTE without cancer.
Asunto(s)
Tromboembolia Venosa/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Austria , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Pronóstico , Estudios Retrospectivos , Caracteres Sexuales , Análisis de Supervivencia , Tasa de Supervivencia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiología , Adulto JovenRESUMEN
Few data are available on long-term survival following venous thromboembolism. We performed a retrospective survival analysis covering the period January 1985 to December 2006 in 728 young women (median age 28.7 years; interquartile range 21.6-36.3 years) with a history of venous thromboembolism who visited our clinic between 1985 and 1998. Mortality information was obtained from the Austrian Central Death Register. Survival of our patients was compared to the general Austrian female population after adjustment for age and calendar period. Overall, 23 patients (3.2%) died, the cumulative relative survival was 1.03 (95% CI 0.99-1.04). Site of venous thromboembolism or triggering factors had no significant influence. Venous thromboembolism does not reduce long-term survival in young women considering our median follow up of 14 years. The risk of fatal bleeding and quality of life should be assessed versus that of fatal recurrent venous thromboembolism when deciding on long-term anticoagulation in young women.