Vucić N, Lang N, Balić S, Pilas V, Anić T, Nadinić V, Brborovic O
Department of Medicine, Holy Ghost General Hospital, Zagreb, Croatia,
Croat Med J. 2000 Jun;41(2):163-7.
To compare the key steps of standard deep-vein thrombosis management with the critical pathway practice guidelines, and to assess the outcome of the treatment after 6 months.
This retrospective cohort study (from January 1, 1997 to December 31, 1998) included 172 patients with uncomplicated deep-vein thrombosis of lower extremities, consecutively admitted via emergency room. The data were collected from the entry register in emergency room and medical charts. The outcome of therapy was assessed 6 months after the acute event.
A bolus dose of heparin was administered to 81 (46%) patients. The recommended initial heparin infusion rate at 1250 U/h was employed in only 26 (15%) patients. Time to activated partial thromboplastin time >60 s was met in 29 (17%) patients. All patients but one received heparin therapy longer than 96 h. The recommended time to a therapeutic international normalized ratio of less than 120 h was achieved in 134 (78%) patients, but the average length of a stay in the hospital exceeded the recommended 5. 5 days by 86%. Six months later, compressive ultrasonography revealed 44 (28.9%) cases of complete vein obstruction, 67 (44.1%) cases of partial recanalization and 41 (27%) cases with a normal finding. Recurrent thrombosis developed in 16 patients (10.5%) and acute pulmonary embolism in 4 (2.6%) patients.
Our results considerably differ from the critical pathway guidelines due to the lower initial heparin doses and longer diagnostic assessment of thrombosis etiology. Our approach to deep-vein thrombosis treatment was a combination of the critical pathway guidelines and the conventional regimen. The clinical outcome in our series did not differ significantly from the outcome after the conventional way of treatment.
比较标准深静脉血栓形成管理的关键步骤与关键路径实践指南，并评估6个月后的治疗结果。
这项回顾性队列研究（1997年1月1日至1998年12月31日）纳入了172例通过急诊室连续收治的下肢单纯性深静脉血栓形成患者。数据从急诊室的入院登记册和病历中收集。在急性事件发生6个月后评估治疗结果。
81例（46%）患者给予了大剂量肝素。仅26例（15%）患者采用了推荐的初始肝素输注速率1250 U/h。29例（17%）患者达到活化部分凝血活酶时间>60秒。除1例患者外，所有患者接受肝素治疗的时间均超过96小时。134例（78%）患者达到了推荐的国际标准化比值<120小时的时间，但平均住院时间比推荐的5.5天超出了86%。6个月后，压迫超声显示44例（28.9%）完全静脉阻塞，67例（44.1%）部分再通，41例（27%）结果正常。16例患者（10.5%）发生复发性血栓形成，4例患者（2.6%）发生急性肺栓塞。
由于初始肝素剂量较低和对血栓形成病因的诊断评估时间较长，我们的结果与关键路径指南有很大差异。我们对深静脉血栓形成的治疗方法是关键路径指南与传统方案的结合。我们系列中的临床结果与传统治疗方法后的结果没有显著差异。
