Kuroiwa Masayuki, Arai Masayasu, Nakahara Eri, Hoka Sumio
Department of Anesthesiology, Kitasato University, School of Medicine, Sagamihara 228-8555.
Masui. 2003 Jul;52(7):744-9.
Venous thromboembolism (VTE) has become a major health problem in Japan.
We examined, postoperative recurrence of VTE in patients with preoperative venous thromboembolic events and evaluated factors that are relevant to the occurrence of postoperative VTE.
Forty-four cases out of 38500 had been diagnosed preoperatively as having VTE in the period of 1995-2001 at Kitasato University Hospital. Postoperative VTE was detected in four patients (9%) out of these 44 cases. Patients who had thrombophilia (antiphosholipid syndrome) or recent episode of VTE within 1 month were higher in the incidence of postoperative recurrence of VTE than the others. Temporary infra-vena cava filters were placed to prevent pulmonary thromboembolism in twelve patients. In 8 of the patients, thrombi were detected in or at the filter before explantation. Three patients (7%) had undergone thrombolysis therapy. Postoperative VTE was not found in patients who had already received anticoagulant therapy (warfarin) for 3 or more months.
It is concluded that newly developed VTE occurred perioperatively in 9% of patients with preoperative VTE, and that thrombophilia and a recent episode of VTE were considered as risk factors of perioperative VTE. Temporary infra-vena cava filters are a valuable device for prevention of postoperative pulmonary thromboembolism.
静脉血栓栓塞症（VTE）已成为日本的一个主要健康问题。
我们研究了术前有静脉血栓栓塞事件的患者术后VTE的复发情况，并评估了与术后VTE发生相关的因素。
在1995 - 2001年期间，北里大学医院38500例患者中有44例术前被诊断为VTE。这44例患者中有4例（9%）检测到术后VTE。有血栓形成倾向（抗磷脂综合征）或在1个月内近期发生过VTE的患者术后VTE复发率高于其他患者。为预防肺血栓栓塞，对12例患者放置了临时下腔静脉滤器。其中8例患者在取出滤器前在滤器内或滤器处检测到血栓。3例患者（7%）接受了溶栓治疗。术前已接受抗凝治疗（华法林）3个月或更长时间的患者未发现术后VTE。
得出结论，术前有VTE的患者中9%在围手术期发生了新的VTE，血栓形成倾向和近期发生的VTE被认为是围手术期VTE的危险因素。临时下腔静脉滤器是预防术后肺血栓栓塞的一种有价值的装置。
