O'Shaughnessy A M, Fitzgerald D E
Vascular Medicine Unit, James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland.
Int Angiol. 2001 Jun;20(2):141-7.
An audit of 100 proximal (above knee) deep vein thromboses (DVT) was carried out to document the dynamic status of the condition during the first year.
Duplex ultrasound was used to diagnose the presence of an acute deep vein thrombosis in a consecutive series of patients. Follow-up bilateral ultrasound scans were performed at one week, one month, six months and at one year and clot retraction, lysis or extension were recorded. The patients' treatment regime and symptoms were also recorded at each follow-up examination.
There were 100 proximal DVT's from 89 patients (11 bilateral thromboses). The patient population included those with a previous history of DVT or in the end stages of a major illness and those with reversible risk factors. The mortality rate over the one-year period was 14 percent, most of the deaths occurring in the first month. The majority of deaths occurred as a result of an underlying primary disease (e.g. cancer) and 3 percent died from a pulmonary embolism. All patients were treated initially with either intravenous (IV) heparin or subcutaneous low molecular weight (SCLMW) heparin. Following heparin all patients were treated with warfarin. The duration of anticoagulant therapy varied with most physicians treating the patient for six months. Symptomatic and asymptomatic events (pulmonary emboli, extension of thrombi, new DVT's) were recorded in the follow-up period especially in the initial and late phase.
The audit concluded that the diagnosis and treatment of DVT continues to be a major clinical problem with uncertainty as to the type and length of treatment required. The mobility of the patient was not considered in the choice of initial heparin treatment. Anticoagulants were generally continued for a period of up to six months regardless of the patient's risk factors. Little consideration was given to asymptomatic events with physicians still depending on unreliable clinical symptoms to determine if recurrences had occurred. Generally, no consideration was given to the long-term consequences of a post-thrombotic limb at the initial stage of treatment of a DVT.
对100例近端（膝上）深静脉血栓形成（DVT）进行了一项审计，以记录该疾病在第一年的动态状况。
采用双功超声对一系列连续患者诊断急性深静脉血栓形成的存在情况。在1周、1个月、6个月和1年时进行双侧超声随访扫描，并记录血栓收缩、溶解或扩展情况。在每次随访检查时还记录患者的治疗方案和症状。
89例患者发生了100例近端DVT（11例双侧血栓形成）。患者群体包括有DVT既往史或处于重大疾病终末期的患者以及具有可逆性危险因素的患者。1年期间的死亡率为14%，大多数死亡发生在第一个月。大多数死亡是由潜在的原发性疾病（如癌症）导致的，3%死于肺栓塞。所有患者最初均接受静脉注射（IV）肝素或皮下低分子量（SCLMW）肝素治疗。肝素治疗后，所有患者均接受华法林治疗。抗凝治疗的持续时间各不相同，大多数医生对患者治疗6个月。在随访期间，尤其是在初始和后期阶段，记录了有症状和无症状事件（肺栓塞、血栓扩展、新的DVT）。
该审计得出结论，DVT的诊断和治疗仍然是一个主要的临床问题，在所需治疗类型和时长方面存在不确定性。在选择初始肝素治疗时未考虑患者的活动能力。无论患者的危险因素如何，抗凝剂通常持续使用长达6个月的时间。对无症状事件考虑甚少，医生仍依赖不可靠的临床症状来确定是否发生复发。一般而言，在DVT治疗初期未考虑血栓形成后肢体的长期后果。
