癌症相关静脉血栓栓塞症患者缺血性中风的发病率和风险因素：来自静脉血栓栓塞症患者当代管理与疗效登记处-2的数据

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2024-11-01 DOI:10.1016/j.rpth.2024.102617

Toru Sato , Yoshito Ogihara , Yugo Yamashita , Takeshi Morimoto , Ryuki Chatani , Kazuhisa Kaneda , Yuji Nishimoto , Nobutaka Ikeda , Yohei Kobayashi , Satoshi Ikeda , Kitae Kim , Moriaki Inoko , Toru Takase , Shuhei Tsuji , Maki Oi , Takuma Takada , Kazunori Otsui , Jiro Sakamoto , Takeshi Inoue , Shunsuke Usami , Kaoru Dohi

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引用次数: 0

摘要

背景缺血性卒中是癌症相关性静脉血栓栓塞症（CAVTE）患者的一种严重并发症，尽管在直接口服抗凝剂时代相关数据仍然很少。方法2015 年 1 月至 2020 年 8 月期间，日本 31 个中心的 5197 名静脉血栓栓塞症（VTE）患者参加了静脉血栓栓塞症患者当代管理和结果登记-2，我们从中选择了 1507 名活动性癌症患者。我们计算了缺血性卒中的累积发病率函数，考虑了死亡的竞争风险，并在多变量分析的子分布危险模型中研究了缺血性卒中的风险因素。结果在中位随访 1020 天期间，71 名患者（4.7%）发生了缺血性卒中，1 年和 3 年的缺血性卒中累积发病率分别为 4.0% 和 4.7%。缺血性卒中的独立危险因素包括胰腺癌（危险比 [HR]，4.24；95% CI，2.13-8.43）、卵巢癌（HR，2.82；95% CI，1.31-6.08）、肺癌（HR，2.35；95% CI，1.20-4.57）、血脂异常（HR，1.76；95% CI，1.01-3.09）、转移（HR，1.70；95% CI，1.02-2.82）、VTE 诊断时较高的 D-二聚体（HR，1.09；95% CI，1.04-1.14）和年龄较小（HR，0.84；95% CI，0.71-0.999）。结论在直接口服抗凝剂时代的这一大型 VTE 登记中，CAVTE 患者缺血性卒中的累积发生率在 1 年为 4.0%，3 年为 4.7%，发现了几个缺血性卒中的独立危险因素，包括胰腺癌、卵巢癌、肺癌、血脂异常、转移、VTE 诊断时 D-二聚体较高和年龄较小。

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Incidence and risk factors of ischemic stroke in patients with cancer-associated venous thromboembolism: from the Contemporary Management and Outcomes in Patients With Venous Thromboembolism Registry-2

Background

Ischemic stroke is a serious complication in patients with cancer-associated venous thromboembolism (CAVTE), although data remain scarce in the direct oral anticoagulant era.

Objectives

This study aimed to investigate the incidence and identify predictive risk factors of ischemic stroke in patients with CAVTE.

Methods

From the Contemporary Management and Outcomes in Patients With Venous Thromboembolism Registry-2 enrolling 5197 venous thromboembolism (VTE) patients across 31 centers in Japan between January 2015 and August 2020, we selected 1507 patients with active cancer. We calculated the cumulative incidence function of ischemic stroke accounting for the competing risk of death and investigated risk factors for ischemic stroke in a subdistribution hazard model of multivariable analysis.

Results

During a median follow-up period of 1020 days, 71 patients (4.7%) developed ischemic stroke, and the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years. Independent risk factors of ischemic stroke included pancreatic cancer (hazard ratio [HR], 4.24; 95% CI, 2.13-8.43), ovarian cancer (HR, 2.82; 95% CI, 1.31-6.08), lung cancer (HR, 2.35; 95% CI, 1.20-4.57), dyslipidemia (HR, 1.76; 95% CI, 1.01-3.09), metastasis (HR, 1.70; 95% CI, 1.02-2.82), higher D-dimer at VTE diagnosis (HR, 1.09; 95% CI, 1.04-1.14), and younger age (HR, 0.84; 95% CI, 0.71-0.999).

Conclusion

In this large VTE registry in the direct oral anticoagulant era, the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years in patients with CAVTE, and several independent risk factors of ischemic stroke were identified, including pancreatic cancer, ovarian cancer, lung cancer, dyslipidemia, metastasis, higher D-dimer at VTE diagnosis, and younger age.

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