Venöz tromboembolizm tanılı hastaların demografik özelliklerinin ve risk faktörlerinin geriye dönük değerlendirilmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Venöz tromboembolizm genellikle alt ekstremite DVT ve PE tanılarını kapsayacak şekilde kullanılsa da splanknik, serebral ve üst ekstremite venleri başta olmak üzere tüm venöz sistemde oluşabilmektedir. Edinilmiş ve kalıtımsal yatkınlıklar ile klinik risk faktörlerinin bir araya gelmesiyle oluşan çoklu etmenli karmaşık bir hastalık olan VTE gelişiminde risk faktörleri arasında ilerleyen yaş, uzamış immobilite, malignite, majör cerrahi, çoklu travma, geçirilmiş VTE ve kronik kalp yetmezliği bulunmaktadır. Çalışmamızda Trakya Üniversitesi Tıp Fakültesi Sağlık Uygulama ve Araştırma Merkezi'nde takip ve tedavisi yapılan VTE tanılı hastaların epidemiyolojik özelliklerinin ve klinik risk faktörlerinin değerlendirilmesi, hasta profilinin geriye dönük olarak incelenmesi hedeflenmiştir. Olguların ortalama yaşı 57,94±16,71 olup erkeklerin yaş ortalaması 57,61±16,18, kadınların yaş ortalaması ise 58,28±17,27 olarak saptanmıştır. 1646 hastanın 268'i (%16,3) 40 yaş altı, 749'u (%45,5) 40-65 yaş arası, 629'u (%38,2) 65 yaş ve üzeri olarak bulunmuştur. DVT, PE veya DVT+PE tanılı olgular çalışmamızdaki olguların %77,2'sini oluşturmaktadır (%30,4'ünde alt ekstremite DVT, %30,7'sinde PE, %16,1'inde DVT+PE). DVT tanılarının %7,0'ını üst ekstremite DVT'leri oluşturmaktadır. 170'inde (%10,3) olağan dışı bölgelerde VTE saptanmıştır. Olağan dışı bölgelerde tromboz tanılarının 105'i portal sistem ilişkili, 35'i serebral venöz sinüs trombozu (SVST), 21'i VCI trombozu, 5'i hepatik ven trombozu, 4'ü renal ven trombozu tanısı almıştır. 110 splanknik sistem trombozu olgusunun lokalizasyonları incelendiğinde %73'ünde PVT, %30'unda mezenterik ven trombozu, %23,7'sinde çoklu vende tromboz, %21,8'inde splenik ven trombozu, %4,5'inde BCS tanısı mevcuttu. VTE gelişme ihtimalini arttıran risk faktörlerinin sıklıkları incelendiğinde; aktif kanser varlığı (%31,8), immobilite (%12,2), son 3 ayda hastane yatış öyküsü (%10,6), cerrahi operasyon öyküsü (%8,5), IV katater öyküsü (%5,6), majör travma (%3,6), gebelik (%1,1), postpartum dönem (%0,9), OKS kullanımı (%1,2) olarak saptanmıştır. Hastane ilişkili tromboz 320 (%19) olguda tespit edilmiştir. Hastane ilişkili VTE'lerin 145'i (%45,3) yatış sırasında tanı almışken 175'i (%54,7) taburculuk sonrası ilk 3 ay içerisinde tanı almış, hastane ilişkili VTE'nin en sık görüldüğü medikal servis nöroloji servisi (hastane ilişkili VTE'lerin %8,2'si) iken, cerrahi bilimlerde ortopedi servisi (hastane ilişkili VTE'lerin %11,9'u) olmuştur. ÜEDVT olgularının %44,8'inde IV katater öyküsü, %51,7'sinde aktif kanser tanısı bulunmaktadır. Splanknik VTE tanısı olan hastaların %36'sında aktif solid kanser, %29'unda karaciğer sirozu, %8,1'inde MPN tetikleyici faktör olarak değerlendirilmiştir. SVST daha genç yaşta ve kadınlarda daha sık görülmüştür. Çalışmamızdaki SVST olgularının %14,2'sinde gebelik/postpartum dönemde olma, %11,4'ünde oral kontraseptif kullanımı, %11,4'ünde Behçet hastalığı, %2,9'unda AFAS, %2,9'unda nefrotik sendrom tetikleyici faktör olarak değerlendirilmiştir. Olguların %4,5'inde FVL heterozigot, %0,9'unda FVL homozigot saptanmıştır. %2,2'sinde PGM heterozigot varyasyonu saptanmıştır Majör travma öyküsü olmayan grupta VTE tekrarlama durumu, majör travma öyküsü olan gruba göre anlamlı olarak yüksek saptanmıştır (p=0,0026).İntravenöz katater öyküsü olmayan grupta VTE tekrarlama oranı IV katater öyküsü olan gruba göre anlamlı olarak yüksek saptanmıştır (p=0,003).Hastane ilişkili trombozu olmayan grupta VTE tekrarlama oranı hastane ilişkili trombozu olanlara göre anlamlı olarak yüksek saptanmıştır (p=0,002).Hareketsizlik öyküsü olmayan grupta VTE tekrarlama oranı hareketsizlik öyküsü olan gruba göre anlamlı olarak yüksek saptanmıştır (p:0,004). Olguların %58,1'i yatarak, %41,9'u sadece ayaktan tedavi almış, %55'i DMAH, %16,3'ü VKA, %26,1'i DOAK tedavisi almıştır.
Although venous thromboembolism is generally used to define lower extremity DVT and PE, it can occur in the entire venous system such as splanchnic, cerebral and upper extremity veins. VTE is a multifactorial complex disease, caused by the combination of acquired and hereditary predispositions and clinical risk factors. There are risk factors which enhance the possibility of VTE occurence that including advancing age, prolonged immobility, malignancy, major surgery, multiple trauma, previous VTE, and chronic heart failure. In our study, it was aimed to evaluate the epidemiological features and clinical risk factors of patients with VTE, who were followed up and treated at Trakya University Medical Faculty Health Practice and Research Center, and to examine the patient profile retrospectively. Mean age of the cases was 57.94±16.71 years, mean age of men was 57.61±16.18 years and the mean age of women was 58.28±17.27 years. Of 1646 patients, 268 (16.3%) were under the age of 40, 749 (45.5%) were between the ages of 40-65, and 629 (38.2%) were aged 65 and over. Cases diagnosed with DVT, PE or DVT+PE constitute 77.2% of the cases in our study (30.4% lower extremity DVT, 30.7% PE, 16.1% DVT+PE). Upper extremity DVTs constitute 7.0% of DVT diagnoses. VTE was detected in 170 (10.3%) of them at unusual sites. 105 of the thrombosis diagnoses in unusual regions were portal system related, 35 cerebral venous sinus thrombosis (CVST), 21 VCI thrombosis, 5 hepatic vein thrombosis, 4 renal vein thrombosis. When the localizations of 110 splanchnic system thrombosis cases were examined, there was a diagnosis of PVT in 73%, mesenteric vein thrombosis in 30%, multiple vein thrombosis in 23.7%, splenic vein thrombosis in 21.8%, and BCS in 4.5%. When the frequencies of risk factors that increase the probability of VTE development are examined; presence of active cancer (31.8%), immobility (12.2%), history of hospitalization in the last 3 months (10.6%), history of surgical operation (8.5%), history of IV catheter (5.6%), major trauma (3.6%), pregnancy (1.1%), postpartum period (0.9%), oral contraceptive use (1.2%) is found. Hospital-associated thrombosis is detected in 320 (19%) cases. While 145 (45.3%) hospital-associated VTEs were diagnosed during hospitalization, 175 (54.7%) were diagnosed within the first 3 months after discharge. The neurology service was the medical service which hospital associated VTE most seen (8,2% of all hospital associated VTEs) and orthopedics was the surgical service(11,9% of hospital-associated VTEs) There is a history of IV catheter in 44.8% and active cancer in 51,7% of UEDVT cases. Among splanchnic VTE cases; active solid cancer (36% of cases), liver cirrhosis (29% of cases) and MPN (8,1% of cases) were evaluated as triggering factors. CVST was more common at younger ages and in women. Pregnancy/postpartum period (14,2% of cases), oral contraceptive use (11,4% of cases), Behçet's disease (11,4% of cases), AFAS (2,9% of cases), nephrotic syndrome (2,9% of cases) was considered as a triggering factor of the CVST cases in our study. FVL heterozygous found 4,5%, FVL homozygous found 0,9% and PGM heterozygous found 2,2% of genetic testing requested patients. The rate of recurrence of VTE was found to be significantly higher in the group without a history of major trauma compared to the group with a history of major trauma (p=0.0026). In the group without hospital-related thrombosis, the rate of recurrence of VTE was found to be significantly higher than those with hospital-related thrombosis (p=0.002). The rate of recurrence of VTE in the group without a history of immobility was found to be significantly higher than in the group with a history of inactivity (p:0.004). 58.1% of the cases received inpatient treatment, 41.9% received only outpatient treatment, 55% received LMWH, 16.3% VKA, 26.1% DOAC treatment.
Although venous thromboembolism is generally used to define lower extremity DVT and PE, it can occur in the entire venous system such as splanchnic, cerebral and upper extremity veins. VTE is a multifactorial complex disease, caused by the combination of acquired and hereditary predispositions and clinical risk factors. There are risk factors which enhance the possibility of VTE occurence that including advancing age, prolonged immobility, malignancy, major surgery, multiple trauma, previous VTE, and chronic heart failure. In our study, it was aimed to evaluate the epidemiological features and clinical risk factors of patients with VTE, who were followed up and treated at Trakya University Medical Faculty Health Practice and Research Center, and to examine the patient profile retrospectively. Mean age of the cases was 57.94±16.71 years, mean age of men was 57.61±16.18 years and the mean age of women was 58.28±17.27 years. Of 1646 patients, 268 (16.3%) were under the age of 40, 749 (45.5%) were between the ages of 40-65, and 629 (38.2%) were aged 65 and over. Cases diagnosed with DVT, PE or DVT+PE constitute 77.2% of the cases in our study (30.4% lower extremity DVT, 30.7% PE, 16.1% DVT+PE). Upper extremity DVTs constitute 7.0% of DVT diagnoses. VTE was detected in 170 (10.3%) of them at unusual sites. 105 of the thrombosis diagnoses in unusual regions were portal system related, 35 cerebral venous sinus thrombosis (CVST), 21 VCI thrombosis, 5 hepatic vein thrombosis, 4 renal vein thrombosis. When the localizations of 110 splanchnic system thrombosis cases were examined, there was a diagnosis of PVT in 73%, mesenteric vein thrombosis in 30%, multiple vein thrombosis in 23.7%, splenic vein thrombosis in 21.8%, and BCS in 4.5%. When the frequencies of risk factors that increase the probability of VTE development are examined; presence of active cancer (31.8%), immobility (12.2%), history of hospitalization in the last 3 months (10.6%), history of surgical operation (8.5%), history of IV catheter (5.6%), major trauma (3.6%), pregnancy (1.1%), postpartum period (0.9%), oral contraceptive use (1.2%) is found. Hospital-associated thrombosis is detected in 320 (19%) cases. While 145 (45.3%) hospital-associated VTEs were diagnosed during hospitalization, 175 (54.7%) were diagnosed within the first 3 months after discharge. The neurology service was the medical service which hospital associated VTE most seen (8,2% of all hospital associated VTEs) and orthopedics was the surgical service(11,9% of hospital-associated VTEs) There is a history of IV catheter in 44.8% and active cancer in 51,7% of UEDVT cases. Among splanchnic VTE cases; active solid cancer (36% of cases), liver cirrhosis (29% of cases) and MPN (8,1% of cases) were evaluated as triggering factors. CVST was more common at younger ages and in women. Pregnancy/postpartum period (14,2% of cases), oral contraceptive use (11,4% of cases), Behçet's disease (11,4% of cases), AFAS (2,9% of cases), nephrotic syndrome (2,9% of cases) was considered as a triggering factor of the CVST cases in our study. FVL heterozygous found 4,5%, FVL homozygous found 0,9% and PGM heterozygous found 2,2% of genetic testing requested patients. The rate of recurrence of VTE was found to be significantly higher in the group without a history of major trauma compared to the group with a history of major trauma (p=0.0026). In the group without hospital-related thrombosis, the rate of recurrence of VTE was found to be significantly higher than those with hospital-related thrombosis (p=0.002). The rate of recurrence of VTE in the group without a history of immobility was found to be significantly higher than in the group with a history of inactivity (p:0.004). 58.1% of the cases received inpatient treatment, 41.9% received only outpatient treatment, 55% received LMWH, 16.3% VKA, 26.1% DOAC treatment.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Hematoloji, Hematology ; İç Hastalıkları
