下肢深静脉血栓的诊治进展

近年来，随着现代血液学的发展，对血栓前状态的研究已深入到分子水平。所谓血栓前状态是指血液有形成分和无形成分的生物化学和流变学发生了病理变化。下肢深静脉血栓形成（deep vein thrombosis，DVT）是指血液在下肢深静脉内不正常的凝结。其发病率在我国尚无确切的统计资料，但是有逐年上升的趋势。下肢DVT形成的血流滞缓、高凝状态以及静脉内膜损伤三大因素至今仍被各国学者所公认。     

深静脉血栓形成的防治

采用尿激酶动脉注射,低分子肝素皮下注射及糖皮质激素、理疗等综合治疗手段治疗深静脉血栓形成8例,治愈7例,死亡1例。上述治疗对深部静脉血栓形成有治疗良好作用。     

抗凝治疗中深静脉血栓的近期演变

回顾性分析60例有症状的DVT患者的系列超声静脉显象资料,探讨在抗凝治疗中DVT的近期演变情况。22例远端DVT患者平均随访28.4(3～95)天,仅1例(4.5％)血栓伸展入近端静脉,未发生肺栓塞者;38例近端DVT患者平均随访45.4(4～165)天,8例(21.1％)血栓继续伸展,2例(5.3％)在其他部位形成新的静脉血栓,4例(10.5％)发生肺栓塞。提示目前的抗凝疗法对远端DVT效果良好而对近端DVT效果欠佳。     

急性肺血栓栓塞症患者溶栓抗凝治疗后深静脉血栓的变化

目的 观察急性肺血栓栓塞症(PTE)患者溶栓抗凝治疗后深静脉血栓(DVT)的变化.方法 从急性PTE溶栓与抗凝治疗多中心研究中选取确诊的于溶栓抗凝治疗前后行下肢静脉超声检查的PTE患者362例,观察治疗前后深静脉血栓的变化.结果溶栓抗凝治疗后14 d与治疗前相比,DVT明显减少(x2=22.667,P<0.001),但有11.6%的患者出现新发或再发DVT.溶栓治疗者血流改善率为56.5%,抗凝治疗者为47.8%,二者间差异无统计学意义(x2=1.435,P=0.231).3个月随访,有30.4%的患者DVT仍未恢复正常,另有10.4%的患者经超声检查发现DVT.结论 溶栓抗凝治疗后14 d,DVT的治愈率较低,新发或再发率较高,溶栓治疗的血流改善与抗凝治疗相仿.短期治疗尚不能显著改善DVT的预后.     

下肢深静脉血栓的彩色多普勒超声诊断

深静脉血栓形成若未及时治疗，将造成程度不一的慢性深静脉功能不全而影响生括和工作，甚至残疾。1998年9月-2005年12月，我们应用彩色多普勒超声诊断下肢深静脉血栓192例。现报告如下。     

特发性深静脉血栓口服抗凝疗法3个月

虽然最近数十年系统性红斑狼疮 (ＳＬＥ)的治疗取得了长足进步 ,但因其并发的心血管病使发病率及死亡率反而上升。本文研究ＳＬＥ罹患心血管病的传统及非传统危险因素。方法　将研究对象分为 3组 :ａ组 :女性ＳＬＥ并发心血管病者 2 6例 ;ｂ组 :女性ＳＬＥ未并发心血管病者 2 6例 ;对照组 :女性无ＳＬＥ及心血管病者 2 6例。研究采用书面问卷、访视及体检方式 ,并进行常规实验室检查、血浆脂蛋白检查 ,化学发光法测定氧化ＬＤＬ自身抗体 ,确定氧化ＬＤＬ抗原表位及颈动脉超声检查。并将 3组检查结果进行单因素方差分析。结果　ＳＬＥ并发及…     

彩超诊断下肢深静脉血栓及病因分析

1998年8月至2003年1月,我们应用彩色多普勒超声(CDFI)确诊下肢深静脉血栓(DVT)252例268条肢体。现报告如下,并探讨其病因、临床表现及预防措施。     

老年人急性深静脉血栓形成的诊治

<正>急性深静脉血栓形成(deep venous thrombosis,DVT)可能引起肺栓塞(pulmonary embolism,PE)或血栓形成后综合征(post thrombotic syndrome,PTS),导致死亡或长期致残。因此,及时诊断和治疗急性DVT非常重要。现有的临床治疗DVT的指南是基于临床试验证据,但临床试验中老年人由于有并发疾病、生存期短、长期制动或治疗禁忌证而经常被排除在临床试验之外,老年人的生理代谢发生了改变,本身自服药物较多,这意味着现有关于DVT的治疗指南对于老年人并不完全适合。     

急性下肢深静脉血栓157例

下肢深静脉血栓形成(DVT)是指血液在下肢深静脉腔内不正常地凝结,阻塞静脉管腔,导致静脉回流障碍的周围血管性疾病[1～3].DVT并发肺栓塞严重时可导致猝死,其后遗症血栓形成后综合征(PTS)也严重影响患者正常生活质量.本文回顾性分析在2008年1月至2011年12月急性下肢DVT患者157例的诊治特点.     

78例下肢深静脉血栓形成的临床分析

静脉血栓症（venous thromboembolism）包括肺栓塞（pulmonary thromboembolism,PTE）和深静脉血栓形成（deep vein thrombosis,DVT）,而相当部分DVT可导致PTE,甚至是致死性的PTE。特别是近年来防治PTE的临床实践表明,防治PTE的发病源头DVT更为重要,从而使深静脉血栓形成的防治受到前所未有的重视。而DVT最常见的是下肢DVT,近年来有明显增加的趋势。为了提高DVT的防治水平,降低DVT的死亡率和致残率。     

Diagnosis of Deep Vein Thrombosis with 99Tcm-Plasmin

ABSTRACT. The diagnostic efficiency of ⁹⁹Tc^m-plasmin test was evaluated by X-ray contrast phlebography in 110 consecutive patients with suspected deep vein thrombosis (DVT). The test was positive in 50 of 55 patients with DVT (sensitivity 91%) and negative in 18 of 55 without DVT (specificity 33%). The positive plasmin test in patients without DVT was in most cases due to another inflammatory process or a post-thrombotic state. The ⁹⁹Tc^m-plasmin test is a rapid and sensitive screening method for the diagnosis of DVT, but as it is based on comparison between the legs, it may be unreliable in cases of bilateral thrombosis. The low specificity makes it less valuable in patients with concomitant inflammatory disease or previous thrombosis in either leg. When the plasmin test is positive, the diagnosis of DVT should in most cases be confirmed by X-ray contrast phlebography.     

Low-Molecular-Weight Heparin in the Initial Treatment of Proximal Deep Vein Thrombosis

Intravenous unfractionated heparin followed by oral warfarin is the current standard of care for the treatment of acute venous thrombosis. More recently, several low-molecular-weight heparin preparations have been shown to be as effective and safe as unfractionated heparin for the initial therapy of acute proximal vein thrombosis. These drugs have a number of advantages over unfractionated heparin, and will undoubtedly replace the current standard for the initial treatment of venous thromboembolism.     

The Duration of Oral Anticoagulation after Deep Vein Thrombosis

ABSTRACT. Schulman S, Lockner D, Juhlin-Dannfelt A. (Thrombosis Unit, Department of Internal Medicine, and Laboratory of Clinical Physiology, Huddinge University Hospital, Huddinge, Sweden.) The duration of oral anticougulation after deep vein thrombosis. Eighty patients with deep vein thrombosis (DVT) were randomized between our routine duration of oral anticoagulation and 50% reduction thereof, in order to evaluate whether shorter therapy could be given without increased risks. The study was stratified, so that 20 patients with the 1st episode of DVT caused by a temporary risk factor were treated for 1.5 or 3 months, 40 patients with the 1st episode of DVT caused by a permanent risk factor for 3 or 6 months, and 20 patients with the 2nd episode of DVT for 6 or 12 months. When warfarin therapy was discontinued, the patients were followed by means of venous occlusion plethysmography every 3 months for 1 year, and clinically for 15–27 months in the different subgroups. Thromboembolic complications were registered and verified by venography and perfusion lung scan. We could not detect any difference between the groups. The rate of rethrombosis and embolism during 12 and 24 months after cessation of anticoagulant therapy was 8 and 10%, respectively, among the patients with reduced duration of treatment and 8 and 14%, respectively, among those with regular duration. One fatal, warfarin-induced hemorrhage occurred. It is important to reduce unnecessary extension of oral anticoagulation after DVT in order to minimize the negative side-effects without increasing the recurrence rate. More extensive trials should be performed to confirm our results and define the optimal duration of treatment.     

Vena Cava Atresia and Deep Vein Thrombosis: A Case Report and Systematic Review

Congenital anomalies of the vena cava often go unnoticed, and their incidental finding is frequent in imaging tests performed for another cause in asymptomatic patients. However, an association with the development of thromboembolic disease has been described, mainly in young patients.We report the case of a young woman with deep vein thrombosis associated with vena cava atresia.We conducted a search of the PubMed/Medline database. The search identified 17 articles, of which 5 were selected for extraction and data analysis. Twelve studies were excluded because they failed to match the main criteria.We identified six new cases of deep vein thrombosis associated with vena cava abnormalities, with a mean age of 42.5 years; 83.3% were male. Regarding clinical manifestations, all patients presented as deep vein thrombosis, one case of recurrence, and another case associated with the kidney and inferior vena cava abnormalities with leg thrombosis syndrome. Only one patient had a target triggering factor (cholecystectomy postoperative). The thrombophilia study was negative in all cases and none of the patients died. Treatment included enoxaparin and vitamin K antagonists.This is the first study to report on a systematic review of vena cava atresia associated with deep vein thrombosis in Spain. It shows that in this region, the disease affects young population—even in the absence of risk factors—and is linked to a low mortality. The most frequent presentation form was deep vein thrombosis. Therefore, congenital abnormalities of the vena cava should be suspected in young patients with thromboembolic disease, due to their implications regarding to the duration of anticoagulant treatment, as well as their possible association with other prothrombotic factors.     

Incidence of Deep Vein Thrombosis in Bedridden Non-surgical Patients

ABSTRACT. In order to detect deep vein thrombosis (DVT), 101 patients with acute medical or infectious disorders were examined with the ¹²⁵I-fibrinogen uptake test. All patients were bedridden on admission and were scanned daily from the second to the eighth day. Thirteen patients developed a positive fibrinogen uptake test. Thus, if a positive test is interpreted as DVT, the incidence of DVT was 13% in our bedridden patients. Of the patients admitted because of heart disease or pneumonia 20% had DVT, but only 4% of those admitted with other diagnoses. Other clinical “risk factors” studied, could not identify patients who developed DVT.     

Diagnosis of Deep Vein Thrombosis with a New Radionuclide Method—99Tcm-Albumin Test

Abstract. The diagnostic efficiency of ⁹⁹Tc^m-albumin test (AT), a new radionuclide method, was evaluated in 90 consecutive patients with suspected deep vein thrombosis (DVT) admitted to the medical emergency ward. Phlebography was used as reference method. The sensitivity of the AT test was 92% and the specificity was 61%. As the method is objective, rapid and convenient for the patients, it can be recommended as an initial examination method to be followed by phlebography, in cases with a positive test result. Criteria with high specificity, 98%, have also been defined but these criteria should be further investigated.     

低分子肝素钙预防心力衰竭患者深静脉血栓观察

目的观察低分子肝素钙对慢性心力衰竭患者深静脉血栓形成的预防效果。方法将未检出深静脉血栓的慢性心力衰竭患者随机分为试验组(95例)和对照组(91例)。在常规治疗基础上,试验组应用低分子肝素钙5 000 U,每日一次皮下注射。对照组应用安慰剂,连续应用2周。于2周及4周后复查下肢深静脉多普勒超声,计算两组深静脉血栓的发生率。结果治疗2周后试验组静脉血栓的发生率为3.1%,对照组为10.9%,两组比较有统计学意义(P<0.0 5);治疗4周后试验组静脉血栓的发生率为4.4%,对照组为13.3%,两组比较有统计学意义(P<0.05)。两组均无严重不良反应。结论应用低分子肝素钙预防慢性心力衰竭患者深静脉血栓形成效果确切,安全性及耐受性良好。     

Deep Vein Thrombosis and Pulmonary Embolism in Cirrhosis Patients

Background and Aims It is a commonly held notion that patients with cirrhosis do not suffer from deep vein thrombosis (DVT) or pulmonary embolism (PE) because they are naturally anticoagulated. However, to date, no studies have been carried out that objectively address this issue. We conducted a study to examine the relationship between cirrhosis and DVT/PE events. Methods A case–control study of patients seen at a tertiary care hospital was performed. Cases were hospitalized patients with biopsy and/or imaging plus clinical evidence of cirrhosis. Well-matched patients with no known evidence of cirrhosis served as controls. The DVT/PE events were identified by the international classification of disease-9 (ICD-9) codes and confirmed with radiographic/nuclear imaging. The Charlson Index was calculated to determine the comorbidity. The incidence of DVT/PE in cirrhotic patients was also compared to patients with chronic kidney disease (CKD), congestive heart failure (CHF), and solid organ cancers. Results This study consisted of 963 cirrhotics and 12,405 controls. Both the incidence of DVT/PE (1.8 vs. 0.9%, P = 0.007) and Charlson Index scores (3.2 ± 1.8 vs. 0.9 ± 1.5, P < 0.001) were higher in cirrhotics than in the controls. However, in the multivariate analysis, the presence of cirrhosis was not associated with DVT/PE [odds ratio (OR) 0.87, P = 0.06]. Partial thromboplastin time (PTT; OR 0.88, P = 0.04) and serum albumin (OR 0.47, P = 0.03) were the independent predictors of DVT/PE. The incidence of DVT/PE in cirrhotics (1.8%) was lower than that in patients with other medical illnesses: 7.1% in CKD, 7.8% in CHF, and 6.1% in cancers. Conclusion Patients with cirrhosis do not have a lower risk of DVT/PE than non-cirrhotic controls without other significant co-morbidities, such as CHF, CKD, and solid organ cancers. Partial thromboplastin time and serum albumin were found to be independently predictive of DVT/PE in cirrhotic patients.