Risk Factors for Progression of Distal Deep Vein Thrombosis
Risk Factors for Progression of Distal Deep Vein Thrombosis
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DOI：
10.1253/circj.cj-20-0270
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发表时间：
2020-10-01
影响因子：
3.3
通讯作者：
Miyaji, Kagami
中科院分区：
文献类型：
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作者：
Fujioka, Shunichiro;Ohkubo, Hirotoki;Miyaji, Kagami
背景：关于远端深静脉血栓（DVT）的最佳治疗方法，包括抗凝治疗的适应症，没有足够的证据。对远端 DVT 患者的治疗结果进行评估，以明确导致远端 DVT 向近端静脉扩展的危险因素以及抗凝治疗的指征。 方法与结果：2018 年 1 月至 2019 年 12 月期间，430 例 DVT 患者中，253 例诊断为远端 DVT；排除41例已开始抗凝治疗的患者，其余212例纳入研究对象。未立即开始抗凝治疗；进行了压力袜保守治疗。 2周后超声检查显示39名患者（21%）血栓消失，38名患者（20%）血栓减少。相比之下，12 名患者 (6.3%) 发现血栓延伸至近端静脉，并开始抗凝治疗。 3个月后，75名患者（52%）的血栓消失了。随访期间没有患者出现肺血栓栓塞。保守治疗期间延伸至近端静脉的危险因素为活动性癌症（P=0.03）、长时间卧床（P8μg/mL（P=0.01））。结论：对于活动性癌症、长期卧床或D-二聚体水平较高的远端DVT患者，考虑抗凝治疗是合理的。
Background: There is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT to the proximal vein and indications for anticoagulation therapy.Methods and Results: Among 430 patients with DVT between January 2018 and December 2019, 253 were diagnosed with distal DVT; 41 patients who had already started anticoagulation therapy were excluded, and the remaining 212 were included as study subjects. Anticoagulation therapy was not started immediately; conservative treatment with compression stockings was performed. Ultrasonography after 2 weeks revealed thrombus disappearance in 39 patients (21%), and thrombus reduction in 38 patients (20%). In contrast, extension of thrombus to the proximal vein was noted in 12 patients (6.3%) and anticoagulation therapy was commenced. After 3 months, the thrombus had disappeared in 75 patients (52%). No patient developed pulmonary thromboembolism during follow-up. With respect to the risk factors for extension to proximal vein during conservative treatment, active cancer (P=0.03), prolonged bed rest (P8 mu g/mL (P=0.01) were identified.Conclusions: It is reasonable to consider anticoagulation therapy in distal DVT patients with active cancer, prolonged bed rest or high D-dimer level.