Holmström M, Aberg W, Lockner D, Paul C
Karolinska Institute at the Dept of Haematology, Huddinge University Hospital, Sweden.
Thromb Haemost. 1999 Oct;82(4):1222-6.
The primary objective of this retrospective study was to describe the frequency of a post-thrombotic syndrome in 265 patients previously treated for deep venous thrombosis (DVT). The secondary objectives were to document the frequency of recurrent venous thromboembolism (VTE) and mortality, especially from malignant disease. The patients were evaluated 5-14 years after inclusion in three randomized trials comparing continuous intravenous (i.v.) infusion of unfractionated heparin (UFH) (n = 85) with a low molecular weight heparin (LMWH), dalteparin (n = 180). The median post-thrombotic score at follow-up was 2 (range 0-8). In a multiple step-wise regression analysis the postthrombotic score was significantly higher among patients with initial proximal DVT (p = 0.0001) as compared with those who had distal DVT. A recurrent venous thromboembolic event was diagnosed in 29.4% of the patients treated with dalteparin and in 23.5% of the patients treated with UFH (ns). A secondary risk factor for venous thromboembolism and a longer duration of treatment with oral anticoagulants (OAC) were significantly associated with a lower risk for recurrent VTE, whereas malignant disease diagnosed during follow-up was associated with a higher risk. During follow-up a total of 40.7% of patients had died. No difference in total mortality or mortality from malignant disease was demonstrated between the two drugs. In conclusion, a severe post-thrombotic syndrome occured relatively infrequent. considering the long observation period. Proximal DVT was significantly associated with a more severe post-thrombotic syndrome. After 14 years follow-up, no significant differences were observed in overall mortality, mortality from malignant disease or recurrent VTE between UFH- and dalteparin-treated patients. Malignant disease was a risk factor for recurrent VTE, the presence of a secondary risk factor and a longer duration of treatment with OAC decreased the risk for recurrent VTE.
这项回顾性研究的主要目的是描述265例既往接受过深静脉血栓形成（DVT）治疗的患者中血栓形成后综合征的发生频率。次要目的是记录复发性静脉血栓栓塞（VTE）和死亡率，尤其是恶性疾病导致的死亡率。这些患者在纳入三项随机试验5至14年后接受评估，这三项试验比较了持续静脉内（i.v.）输注普通肝素（UFH）（n = 85）与低分子量肝素（LMWH）达肝素（n = 180）的效果。随访时血栓形成后评分的中位数为2（范围0 - 8）。在多步逐步回归分析中，与远端DVT患者相比，初始近端DVT患者的血栓形成后评分显著更高（p = 0.0001）。接受达肝素治疗的患者中有29.4%被诊断为复发性静脉血栓栓塞事件，接受UFH治疗的患者中有23.5%（无显著差异）。静脉血栓栓塞的次要危险因素和口服抗凝剂（OAC）治疗时间较长与复发性VTE风险较低显著相关，而随访期间诊断出的恶性疾病与较高风险相关。随访期间共有40.7%的患者死亡。两种药物在总死亡率或恶性疾病死亡率方面未显示出差异。总之，考虑到观察期较长，严重的血栓形成后综合征相对不常见。近端DVT与更严重的血栓形成后综合征显著相关。经过14年的随访，UFH治疗组和达肝素治疗组患者在总死亡率、恶性疾病死亡率或复发性VTE方面未观察到显著差异。恶性疾病是复发性VTE的危险因素，次要危险因素的存在和OAC治疗时间较长可降低复发性VTE的风险。
