Role of a Novel Exercise Program to Prevent Post-thrombotic Syndrome

描述（由申请人提供）： 尽管有标准护理，但25%-50%的急性深静脉血栓形成（DVT）患者进展为慢性血栓形成后综合征（PTS），导致严重残疾、生产力损失和医疗保健成本。这是一个经常遇到的问题，在我们众多的退伍军人接受手术，麻醉，创伤和急性损伤，外科重症监护。组织化血栓引起的静脉瓣膜返流是PTS的主要原因。血栓迅速完全消退的静脉返流发生率较低。我们已经观察到，血栓的溶解是通过增加血流量来增强的，并且适度的上肢或下肢运动会导致静脉血流量增加。因此，我们假设，对DVT患者进行渐进式运动训练计划将增加下肢静脉血流量，加速血栓消退，并降低PTS的风险。主要假设是通过血栓的血流增加（由监督运动引起）将加速血栓消退并降低PTS。总体目标是确定运动是否可以降低急性DVT患者PTS的风险，并研究发生这种情况的可能机制。我们提出了一项为期2年的随机临床试验，比较标准治疗与标准治疗加运动治疗急性下肢DVT患者。目标1将测试3个月的运动训练计划是否可以预防PTS并在2年的随访中改善生活质量。急性下肢DVT（髂股腘动脉）患者将随机接受标准治疗（对照组接受：抗凝、压迫、自由活动）或运动加标准治疗。该研究将招募164名患者 达到80%的把握度，以检测运动组与标准治疗组在2年时PTS患病率降低50%，以及在2年随访期间PTS严重程度降低。目的2将研究运动计划预防PTS的机制，即纤维蛋白溶解和血栓消退的全身标志物。目的3探讨运动疗法更直接的降低PTS的机制，即：改善静脉血流动力学和功能能力。总的来说，这些结果将使我们了解一个新概念模型的基础，即渐进式有氧运动和抗阻运动通过增强血栓溶解、纤维蛋白溶解和血管修复、小腿肌肉泵作用和功能的机制来帮助治疗DVT和预防PTS。能力。这将是一种新的治疗干预，用于维持和恢复DVT后的组织功能。

DESCRIPTION (provided by applicant): Despite standard care, 25%-50% of patients with acute deep vein thrombosis (DVT) progress to chronic post- thrombotic syndrome (PTS) resulting in significant disability, loss of productivity, and healthcare costs. This is a problem encountered frequently among our numerous Veterans undergoing surgery, anesthesia, traumatic and acute injury, and surgical critical care. Venous valvular reflux from an organized thrombus is the primary cause of PTS. Veins with rapid and complete thrombus resolution have a lower incidence of reflux. We have observed that thrombus resolution is enhanced by increased blood flow and that moderate upper or lower extremity exercise result in increased venous blood flow. Hence, we postulate that a progressive exercise training program in patients with DVT will increase lower extremity venous flow, accelerate thrombus resolution, and decrease the risk of PTS. The primary hypothesis is that increased blood flow across the thrombus (induced by supervised exercise) will accelerate thrombus resolution and decrease PTS. The overall goal is to determine whether exercise can lower the risk of PTS in patients with acute DVT, and to investigate possible mechanisms by which this occurs. We propose a 2-year randomized clinical trial of standard therapy compared to standard therapy plus exercise in patients with acute lower extremity DVT. Aim 1 will test whether a 3-month exercise training program prevents PTS and improves quality of life over 2 years of follow-up. Patients with acute lower extremity DVT (iliac-femoral-popliteal) will be randomized to standard therapy (control group receiving: anticoagulation, compression, ambulation ad-lib) alone, or to exercise plus standard therapy. The study will recruit 164 patients to achieve 80% power to detect a 50% decrease in prevalence of PTS at 2 years, and a decrease in severity of PTS through 2 years of follow-up in the exercise group vs. standard care. Aim 2 will investigate mechanisms by which the exercise program may act to prevent PTS, namely systemic markers of fibrinolysis and thrombus resolution. Aim 3 will investigate alternate mechanisms of decreased PTS that are more direct results of the exercise therapy, namely: improving venous hemodynamics and functional capacity. Collectively, these results will allow us to understand the basis of a novel conceptual model that progressive aerobic and resistive exercise aids in the treatment of DVT and prevention of PTS through mechanisms of enhanced thrombus resolution, fibrinolytic and vascular repair, calf muscle pump action, and functional ability. This will be a novel therapeutic intervention for maintenance and restoration of tissue function after DVT.