Schwarcz T H, Quick R C, Minion D J, Kearney P A, Kwolek C J, Endean E D
Department of Surgery, Section of Vascular Surgery, University of Kentucky Chandler Medical Center, Lexington 40536, USA.
J Vasc Surg. 2001 Sep;34(3):447-52. doi: 10.1067/mva.2001.117146.
The value of surveillance venous duplex scanning for detecting unsuspected deep venous thrombosis (DVT) in trauma patients who are receiving enoxaparin prophylaxis is open to question. This study was undertaken to determine whether enoxaparin reduced the clinical utility of surveillance scanning and whether management of these patients was altered by findings of the scans.
The medical records of trauma patients who met defined criteria for high DVT risk, admitted during 30 consecutive months, were reviewed. These patients received enoxaparin 30 mg every 12 hours for the duration of their admissions. Per protocol, surveillance lower extremity venous duplex scans were performed within 72 hours of enoxaparin administration and then weekly until patients were discharged from the hospital. The records were reviewed for thromboembolic events (DVT or pulmonary embolism [PE]), patient location and ambulatory status, therapeutic interventions (systemic anticoagulation, vena cava filter), and complications of enoxaparin therapy.
A total 241 patients underwent 513 venous duplex examinations (1-13 per patient). Eight patients had DVT on the initial scan; seven of these patients were asymptomatic. Five were treated with anticoagulation and/or vena cava filter placement. Of the 233 patients with initially negative duplex scan results, five patients (2%) developed clinically unsuspected lower extremity DVT while hospitalized. All of these five patients were in an intensive care unit. Three of the five patients had no change in treatment. Two of the five underwent anticoagulation, and one vena cava filter was placed. PE occurred in two hospitalized patients, one of whom was ambulatory, with negative duplex scan results. After hospital discharge, six other patients had symptomatic DVT or PE despite in-hospital scans with negative results. Complications associated with enoxaparin included hemorrhage (2) and thrombocytopenia (8).
After initial negative scan results, repeat surveillance duplex scanning during hospitalization detected a low incidence (2%) of DVT in high-risk patients. Furthermore, the detection of unsuspected DVT altered the clinical management of less than 1% of the patients tested. Thus, after a venous duplex scan with negative results and initiation of enoxaparin prophylaxis, subsequent surveillance duplex examinations are not warranted in asymptomatic trauma patients.
对于接受依诺肝素预防治疗的创伤患者，监测静脉双功扫描检测未被怀疑的深静脉血栓形成（DVT）的价值存在疑问。本研究旨在确定依诺肝素是否降低了监测扫描的临床效用，以及这些患者的管理是否因扫描结果而改变。
回顾了连续30个月内收治的符合高DVT风险定义标准的创伤患者的病历。这些患者在住院期间每12小时接受30mg依诺肝素治疗。按照方案，在给予依诺肝素后72小时内进行监测下肢静脉双功扫描，然后每周进行一次，直至患者出院。审查记录中的血栓栓塞事件（DVT或肺栓塞[PE]）、患者位置和活动状态、治疗干预措施（全身抗凝、腔静脉滤器）以及依诺肝素治疗的并发症。
共有241例患者接受了513次静脉双功检查（每位患者1 - 13次）。8例患者在初次扫描时发现DVT；其中7例患者无症状。5例患者接受了抗凝和/或腔静脉滤器置入治疗。在233例初次双功扫描结果为阴性的患者中，5例患者（2%）在住院期间出现了临床未被怀疑的下肢DVT。这5例患者均在重症监护病房。5例患者中有3例治疗无变化。5例患者中有2例接受了抗凝治疗，1例置入了腔静脉滤器。2例住院患者发生了PE，其中1例患者活动自如，双功扫描结果为阴性。出院后，另有6例患者尽管住院期间扫描结果为阴性，但仍出现了有症状的DVT或PE。与依诺肝素相关的并发症包括出血（2例）和血小板减少（8例）。
初次扫描结果为阴性后，住院期间重复监测双功扫描在高危患者中检测到DVT的发生率较低（2%）。此外，未被怀疑的DVT的检测改变了不到1%受检患者的临床管理。因此，在静脉双功扫描结果为阴性并开始依诺肝素预防治疗后，如果创伤患者无症状，则无需进行后续监测双功检查。
