Savage K J, Wells P S, Schulz V, Goudie D, Morrow B, Cruickshank M, Kovacs M J
University of Western Ontario, Ottawa, Canada.
Thromb Haemost. 1999 Sep;82(3):1008-10.
Upper extremity deep vein thrombosis (DVT) is now recognized as a major cause of morbidity and mortality. There is little information regarding the most effective treatment of this condition. We report a prospective cohort study of the use of low molecular weight heparin (LMWH) in the outpatient management of upper extremity DVT. Forty-six patients were managed as outpatients for objectively documented upper extremity DVT with dalteparin (200 aXa u/kg), for a minimum of five days. Warfarin was usually initiated on the first day with a target INR of 2.0-3.0. Most patients had an underlying malignancy or a history of a central line. All patients were followed for 12 weeks from diagnosis. Only one patient had a major bleed. No patients developed pulmonary emboli. One patient had a recurrence of DVT during the treatment with LMWH with extension of the existing thrombus. Seven patients died, all due to their underlying disease. This study supports the safety and effectiveness of dalteparin in the treatment of upper extremity DVT. Given that these patients were treated as outpatients, there is a potential for huge cost savings.
上肢深静脉血栓形成（DVT）目前被认为是发病和死亡的主要原因。关于这种疾病最有效的治疗方法，相关信息较少。我们报告了一项关于低分子量肝素（LMWH）用于上肢DVT门诊治疗的前瞻性队列研究。46例经客观记录患有上肢DVT的患者作为门诊病人接受达肝素（200抗Xa单位/千克）治疗，为期至少5天。华法林通常在第一天开始使用，目标国际标准化比值（INR）为2.0 - 3.0。大多数患者有潜在的恶性肿瘤或中心静脉置管史。所有患者从诊断开始随访12周。只有1例患者发生大出血。没有患者发生肺栓塞。1例患者在使用LMWH治疗期间DVT复发，现有血栓扩展。7例患者死亡，均死于其基础疾病。本研究支持达肝素治疗上肢DVT的安全性和有效性。鉴于这些患者作为门诊病人接受治疗，有可能大幅节省费用。
