目的 探讨延展期抗凝是否可以降低特发性静脉血栓栓塞症（VTE）结局事件的发生率。 方法 收集 2013 年 1 月 1 日至 2016 年 12 月 31 日在开滦总医院确诊为特发性 VTE 的患者 306 例，均已完 成抗凝 3 个月，年龄 24～85 岁，随机分为标准抗凝组和延展期抗凝组进行治疗，共随访 36 个月，主要结 局事件为 VTE 首次复发，次要结局事件为大出血及临床相关非大出血。结果 共 306 例 VTE 患者纳 入分析，年龄（61.54 ± 11.54）岁，男性 184 例（60.13%）。标准抗凝组（n = 155）VTE 复发 45 例，大出血 3 例，临床相关非大出血 21 例；延展期抗凝组（n = 151）VTE 复发 8 例，大出血 5 例，临床相关非大出血 30 例。延展期抗凝治疗较标准治疗能显著降低 VTE 复发的发生率（log⁃rank 检验，P < 0.000 1），未发现延 展期抗凝治疗增加大出血和临床相关非大出血的发生率（log⁃rank 检验，所有 P = 0.458 8）。与标准抗凝 治疗相比，延展期抗凝治疗能显著降低 VTE 复发的风险（HR = 0.44，95%CI：0.19 ~ 0.99）。延展期抗凝治 疗未增加 VTE 大出血和临床相关非大出血的风险，HR（95%CI）分别为 1.00（0.24，4.19）、1.71（0.83，3.51）。 结论 行延展期抗凝治者 VTE 患者复发率低于行标准抗凝治者，大出血和临床相关非大出血发生率较 行标准抗凝治者并未增加，延展期抗凝治疗对于预防特发性 VTE 患者复发有较高应用价值。 

Objective Idiopathic venous thromboembolism（VTE）has high prevalence，risk and recur⁃ rence. The purpose of this study was to investigate whether prolonged anticoagulation can reduce the incidence of VTE outcome events. Methods We selected 306 patients diagnosed with idiopathic VTE in Kailuan General Hos⁃ pital，from January 1，2013 to December 31，2016. All the patients（aged 24 to 85 years）with anticoagulation for 3 months were randomly divided into conventional anticoagulant group and prolonged anticoagulant group with a follow⁃ up of36 months. The primary outcome event was the recurrence of VTE and secondary outcome events were bleed⁃ ing，including major bleeding and clinically related non ⁃ major bleeding. Results A total of 306 VTE patients were included in the analysis，with a mean age of（61.54 ± 11.54）years and 184 males（60.13%）. In the conven⁃ tional anticoagulation group（n = 155），there were 45 VTE recurrence，3 major bleeding，and 21 clinically relevant non ⁃major bleeding；in the prolonged anticoagulation group（n = 151），there were 8 VTE recurrence，5 major bleeding and 30 clinically relevant non⁃major bleeding. Prolonged anticoagulation therapy significantly reduced the incidence of VTE recurrence when compared with conventional anticoagulation therapy（log⁃rank test，P < 0.000 1）， and no significant increase of major bleeding and clinically relevant non ⁃major bleeding（log ⁃ rank test，all P = 0.458 8）were observed. Prolonged anticoagulation therapy significantly reduced the risk of VTE recurrence com⁃ pared to conventional anticoagulation therapy（HR = 0.44，95%CI：0.19 ~ 0.99）. Moreover，prolonged anticoagula⁃ tion therapy didn′t increase the risk of major bleeding and clinically relevant non⁃major bleeding in VTE，with HR （95%CI）of 1.00（0.24，4.19），1.71（0.83，3.51），respectively. Conclusion The recurrence rate of VTE patients in the prolonged anticoagulant group is lower than that in the conventional anticoagulant group，and the incidence of major hemorrhage and clinically related non⁃major hemorrhage donot increase. The prolonged anticoagulant therapy has high application value for preventing the recurrence in patients with idiopathic VTE.