Piovella Franco, Crippa Luciano, Barone Marisa, Viganò D'Angelo Silvana, Serafini Silvia, Galli Laura, Beltrametti Chiara, D'Angelo Armando
Servizio Malattie Tromboemboliche, IRCCS Policlinico San Matteo, Pavia, Italy.
Haematologica. 2002 May;87(5):515-22.
Delayed thrombus regression after a first episode of deep vein thrombosis (DVT) of the inferior limbs has been implicated in the development of the post-thrombotic syndrome. Whether normalization of vein segments involved in the index DVT has prognostic significance with respect to the probability of DVT recurrence or new thrombosis is currently unknown. In this study, we prospectively monitored thrombus regression in consecutive patients with symptomatic and asymptomatic DVT. Factors affecting normalization rates and the relationship between previous normalization and DVT recurrence or new thrombosis were explored.
One hundred and seventy-nine patients with a first episode of symptomatic DVT of the lower limbs (38 with cancer) and 104 patients with DVT occurring after hip replacement surgery were serially monitored by real time B-mode compression ultrasonography (C-US) over a period of 12 months (months 1, 3, 6 and 12). C-US normalization of popliteal and femoral venous segments was arbitrarily assigned to be residual thrombus occupying, at maximum compressibility, less than 40% of the vein area in the absence of compression.
In patients with no DVT recurrence or new thrombosis, C-US normalization was observed at 12 months in 100% of 99 patients with post-operative DVT, in 59% of 134 cancer-free symptomatic DVT outpatients and in 23.3% of 30 symptomatic DVT outpatients with cancer (p = 0.0001). Independent negative effects on the probability of C-US normalization were observed for younger age (p <0.05), for the outpatient presentation of the index DVT (p 0.017), for DVT involving the entire femoro-popliteal axis (p 0.05), and for the presence of cancer (p 0.05). DVT recurrence or new thrombosis was observed in 5 patients with post-operative DVT (4.8%), in 7 cancer-free patients with symptomatic DVT (5.0%) and in 8 patients with cancer (21.1%). Only 4 of these patients had shown normalization of their index DVT prior to the event. The presence of cancer was the only significant predictor of DVT recurrence and/or new thrombosis occurring within 3 months from the index DVT (OR = 4.90, p = 0.002). The absence of previous C-US normalization was the only predictor of recurrence or new thrombosis occurring after 3 and 6 months from the index DVT (OR 5.26, p 0.027).
Absence of C-US normalization after a first episode of DVT appears to be a factor favoring recurrence or new thrombosis and may be relevant to the optimal duration of oral anticoagulant treatment.
下肢深静脉血栓形成（DVT）首发后血栓延迟消退与血栓形成后综合征的发生有关。首次DVT所累及静脉段的恢复正常对于DVT复发或新血栓形成的可能性是否具有预后意义目前尚不清楚。在本研究中，我们对有症状和无症状DVT的连续患者进行了血栓消退的前瞻性监测。探讨了影响恢复正常率的因素以及既往恢复正常与DVT复发或新血栓形成之间的关系。
179例下肢首发有症状DVT患者（38例患有癌症）和104例髋关节置换术后发生DVT的患者，通过实时B型加压超声（C-US）连续监测12个月（第1、3、6和12个月）。腘静脉和股静脉段的C-US恢复正常被定义为在无压迫情况下，最大可压缩时残留血栓占据静脉面积小于40%。
在无DVT复发或新血栓形成的患者中，99例术后DVT患者中有100%在12个月时C-US恢复正常，134例无癌症的有症状DVT门诊患者中有59%恢复正常，30例有癌症的有症状DVT门诊患者中有23.3%恢复正常（p = 0.0001）。年龄较小（p <0.05）、首发DVT为门诊表现（p = 0.017）、DVT累及整个股腘轴（p = 0.05）以及患有癌症（p = 0.05）对C-US恢复正常的可能性有独立的负面影响。5例术后DVT患者（4.8%）、7例无癌症的有症状DVT患者（5.0%）和8例癌症患者（21.1%）发生了DVT复发或新血栓形成。这些患者中只有4例在事件发生前其首发DVT已恢复正常。癌症的存在是首发DVT后3个月内发生DVT复发和/或新血栓形成的唯一显著预测因素（OR = 4.90，p = 0.002）。既往C-US未恢复正常是首发DVT后3个月和6个月后发生复发或新血栓形成的唯一预测因素（OR = 5.26，p = 0.027）。
DVT首发后C-US未恢复正常似乎是有利于复发或新血栓形成的一个因素，可能与口服抗凝治疗的最佳持续时间有关。
