Ageno W, Steidl L, Piantanida E, Dentali F, Mera V, Squizzato A, Marchesi C, Venco A
Department of Internal Medicine, Ospedale di Circolo, University of Insubria, Varese, Italy.
Thromb Res. 2002 Nov 25;108(4):203-7. doi: 10.1016/s0049-3848(03)00063-x.
Delayed thrombus regression after deep vein thrombosis (DVT) of the lower limbs is associated with increased risk of DVT recurrence. Predictors of residual venous occlusion are unknown. We hypothesized that obesity, which causes reduced fibrinolytic activity, can predict delayed thrombus regression.
In a prospective cohort study, 98 patients with objective diagnosis of DVT underwent compression ultrasonography (CUS) after 6 and 12 months. Persistent occlusion was arbitrarily defined as a thrombus occupying, at maximal point of compressibility, more than 20% of the vein area in the absence of compression. The body mass index (BMI) and waist circumference were measured at baseline and at follow up to assess individual patterns of body fat distribution. Information on antithrombotic treatment, family history of varicose veins, cigarette smoking, concomitant disorders, the presence of known risk factors for DVT, the duration of anticoagulant treatment and the use of elastic stockings was collected.
Post-thrombotic recanalization was documented in 34 patients (34.7%) at 6 months and in 44 patients (44.9%) at 12 months. There was no difference in the mean BMI (p=0.469 at 12 months), in the prevalence of obesity (p=0.479) and visceral pattern of body fat distribution (p=0.239) between patients who did and did not show thrombus regression. The presence of a permanent risk factor for DVT was the only predictor of delayed thrombus regression (OR 11.0, 95% CI 1.359-61.978).
Despite consistent evidence of impaired fibrinolysis, obesity is not associated with persistent venous obstruction.
下肢深静脉血栓形成（DVT）后血栓延迟消退与DVT复发风险增加相关。残余静脉闭塞的预测因素尚不清楚。我们推测，导致纤溶活性降低的肥胖可预测血栓延迟消退。
在一项前瞻性队列研究中，98例经客观诊断为DVT的患者在6个月和12个月后接受了加压超声检查（CUS）。持续性闭塞被任意定义为在无压迫情况下，血栓在可压缩的最大点占据静脉面积超过20%。在基线和随访时测量体重指数（BMI）和腰围，以评估个体的体脂分布模式。收集有关抗血栓治疗、静脉曲张家族史、吸烟、伴随疾病、已知DVT危险因素的存在情况、抗凝治疗持续时间以及弹性袜使用情况的信息。
6个月时34例患者（34.7%）记录有血栓形成后再通，12个月时44例患者（44.9%）记录有血栓形成后再通。有和没有血栓消退的患者之间，平均BMI（12个月时p=0.469）、肥胖患病率（p=0.479）和内脏型体脂分布（p=0.239）没有差异。DVT永久性危险因素的存在是血栓延迟消退的唯一预测因素（OR 11.0，95%CI 1.359 - 61.978）。
尽管有一致的证据表明纤溶功能受损，但肥胖与持续性静脉阻塞无关。
