首次肺栓塞或深静脉血栓后，与人口对照组的时间趋势及过量死亡率

Time Trends and Excess Mortality Compared to Population Controls after a First-Time Pulmonary Embolism or Deep Vein Thrombosis

THROMBOSIS AND HAEMOSTASIS

影响因子:4.3

分区:医学2区 Top / 血液学2区外周血管病2区

发表日期:2025 Apr

作者: Katarina Glise Sandblad, Carl Johan Svensson, Kristina Svennerholm, Jacob Philipson, Aldina Pivodic, Sam Schulman, Mazdak Tavoly

DOI: 10.1055/a-2402-6192

摘要

关于肺栓塞（PE）和深静脉血栓（DVT）患者相较于普通人群的过量死亡率时间趋势的最新数据较少。瑞典一项全国性登记研究（2006年至2018年）包括68,960例PE和70,949例DVT病例，并与人口对照组匹配。采用泊松回归分析30天和1年死亡率的相对风险（RR），用Cox回归分析调整后的风险比（aHR）。显著性水平设定为0.001。在PE病例中，30天死亡率（2006年的12.5%降至2018年的7.8%，RR：0.95 [95% CI：0.95-0.96]，p<0.0001）和1年死亡率（26.5%降至22.1%，RR：0.98 [0.97-0.98]，p<0.0001）在研究期间均有所下降。与对照组相比，30天（aHR：33.08 [95% CI：25.12-43.55]降至24.64 [95% CI：18.81-32.27]，p=0.0015）和1年（aHR：5.85 [95% CI：5.31-6.45]升至7.07 [95% CI：6.43-7.78]，p=0.038）过量死亡率没有显著变化。在基线前未发现癌症的PE患者中，30天过量死亡率显著下降（aHR：39.93 [95% CI：28.47-56.00]降至24.63 [95% CI：17.94-33.83]，p=0.0009），而在存活至获得抗凝药物处方的PE患者中，1年过量死亡率增加（aHR：3.55 [95% CI：3.16-3.99]升至5.38 [95% CI：4.85-5.98]，p<0.0001）。DVT病例的30天和1年死亡率有所下降，但与对照组的过量死亡率稳定。总体而言，PE和DVT的死亡率改善与人口趋势同步。然而，无癌症的PE患者的30天过量死亡率持续下降，存活至获得抗凝药物处方的患者则显示出1年过量死亡率的增加。作者署名。本文为Thieme根据创意共享署名-非商业性使用-非衍生作品3.0许可证发布的开放获取文章，允许复制和再现，但须给予适当署名。内容不得用于商业目的，也不得被改编、混合、转化或基于其创作。 (https://creativecommons.org/licenses/by-nc-nd/4.0/)。

Abstract

Recent data on temporal trends in excess mortality for patients with pulmonary embolism (PE) and deep vein thrombosis (DVT) compared with the general population are scarce.A nationwide Swedish register study conducted from 2006 to 2018 including 68,960 PE and 70,949 DVT cases matched with population controls. Poisson regression determined relative risk (RR) for 30-day and 1-year mortality trends while Cox regression determined adjusted hazard ratios (aHRs). A significance level of 0.001 was applied.In PE cases, both 30-day mortality (12.5% in 2006 to 7.8% in 2018, RR: 0.95 [95% CI: 0.95-0.96], p < 0.0001) and 1-year mortality (26.5 to 22.1%, RR: 0.98 [0.97-0.98], p < 0.0001) decreased during the study period. Compared with controls, no significant change was seen in 30-day (aHR: 33.08 [95% CI: 25.12-43.55] to 24.64 [95% CI: 18.81-32.27], p = 0.0015 for interaction with calendar year) or 1-year (aHR: 5.85 [95% CI: 5.31-6.45] to 7.07 [95% CI: 6.43-7.78], p = 0.038) excess mortality. The 30-day excess mortality decreased significantly (aHR: 39.93 [95% CI: 28.47-56.00) to 24.63 [95% CI: 17.94-33.83], p = 0.0009) in patients with PE without known cancer before baseline, while the excess 1-year mortality increased (aHR: 3.55 [95% CI: 3.16-3.99] to 5.38 [95% CI: 4.85-5.98], p < 0.0001) in PE cases surviving to fill a prescription of anticoagulation. In DVT cases, 30-day and 1-year mortality declined, while excess mortality compared with controls remained stable.In general, the improved mortality following PE and DVT paralleled population trends. However, PE cases without cancer had decreasing excess 30-day mortality, whereas those surviving to fill a prescription for anticoagulant medication showed increasing excess 1-year mortality.The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).