Ambrosetti Marco, Salerno Mario, Zambelli Mara, Mastropasqua Filippo, Tramarin Roberto, Pedretti Roberto F E
Division of Cardiology, IRCCS Fondazione Salvatore Maugeri, Institutes of Tradate, Italy.
Chest. 2004 Jan;125(1):191-6. doi: 10.1378/chest.125.1.191.
Little information is available about the prevalence of deep vein thrombosis (DVT) after discharge from cardiac surgery units and its impact on rehabilitation programs.
To estimate the rate of DVT, in relation to different thromboprophylaxis strategies, in patients with a recent coronary artery bypass graft (CABG) entering cardiac rehabilitation.
Two hundred seventy consecutive patients admitted to three rehabilitation facilities after CABG surgery from 19 cardiac surgery units (male patients, 81%; mean +/- SD age, 64 +/- 9 years; interval after operation, 4 to 19 days) underwent serial leg venous ultrasound examination on admission to three rehabilitative units.
At admission, antiplatelet treatment was present in all patients except 10 with absolute contraindications. In 171 patients (63%), heparin prophylaxis (low-molecular-weight heparin once daily, 87%; unfractionated heparin twice daily, 13%) was reported, limited to the early postoperative period (< or = 3 days) in 102 patients (38%). DVT was detected in 47 patients (17.4%). The rate of proximal and isolated distal DVT was 2.6% (7 cases) and 14.8% (40 cases), respectively. DVT was complicated in two cases (0.7%) by symptomatic pulmonary embolism, fatal in one case (0.4%). Clots were found in the leg contralateral to the saphenous vein harvest site in half of all DVT cases. Forty-three DVT cases (91%) were diagnosed at admission, while serial ultrasound testing allowed diagnosis of an additional 4 distal DVT cases. At multivariate analysis, female sex (p < 0.001) and length of stay in the surgery unit > 8 days (p < 0.05) were independently associated with risk of DVT in the rehabilitation setting. The adoption of heparin prophylaxis until discharge predicted the absence of DVT after adjustment for immobility (p < 0.05).
This study showed a high rate of DVT in patients entering cardiac rehabilitation after CABG surgery. Wearing unilateral graded compression stockings after CABG surgery had limited efficacy, as clots were often localized in legs contralateral to the saphenous vein harvest site.
关于心脏外科病房出院后深静脉血栓形成（DVT）的患病率及其对康复计划的影响，目前可获得的信息较少。
评估近期接受冠状动脉旁路移植术（CABG）并进入心脏康复阶段的患者中，与不同血栓预防策略相关的DVT发生率。
来自19个心脏外科病房的270例连续接受CABG手术后入住3个康复机构的患者（男性患者占81%；平均年龄±标准差为64±9岁；术后间隔时间为4至19天）在进入3个康复机构时接受了系列腿部静脉超声检查。
入院时，除10例有绝对禁忌证的患者外，所有患者均接受抗血小板治疗。171例患者（63%）报告接受了肝素预防（每天1次低分子肝素，占87%；每天2次普通肝素，占13%），其中102例患者（38%）仅限于术后早期（≤3天）。47例患者（17.4%）检测到DVT。近端DVT和孤立性远端DVT的发生率分别为2.6%（7例）和14.8%（40例）。2例患者（0.7%）的DVT并发有症状性肺栓塞，1例死亡（0.4%）。所有DVT病例中有一半在与大隐静脉采集部位对侧的腿部发现血栓。43例DVT病例（91%）在入院时被诊断，而系列超声检查又诊断出另外4例远端DVT病例。多因素分析显示，女性（p<0.001）和在外科病房住院时间>8天（p<0.05）与康复环境中DVT风险独立相关。在调整活动量后，采用肝素预防直至出院可预测无DVT发生（p<0.05）。
本研究显示CABG手术后进入心脏康复的患者中DVT发生率较高。CABG手术后穿戴单侧分级压力袜的效果有限，因为血栓常位于与大隐静脉采集部位对侧的腿部。
