van Dongen C J J, Prandoni P, Frulla M, Marchiori A, Prins M H, Hutten B A
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, Netherlands.
J Thromb Haemost. 2005 May;3(5):939-42. doi: 10.1111/j.1538-7836.2005.01333.x.
About 30% of patients with an episode of adequately treated deep venous thrombosis (DVT) develop the postthrombotic syndrome (PTS) within 2 years. During treatment with vitamin K antagonists (VKA) patients spend only 60% of time between an International Normalized Ratio (INR) of 2.0 and 3.0. We hypothesized that patients who spend a large amount of their time beneath this range will have an increased risk of the PTS.
To investigate the relation between the quality of anticoagulant therapy with VKA and the risk of the development of the PTS.
The time spent beneath the therapeutic range was calculated for patients with a first episode of DVT, who were treated with VKA for at least 3 months. At follow-up assessments for a maximum of 5 years, presence and severity of signs and symptoms of PTS were recorded.
A total of 244 patients, with a median duration of follow-up of 4.9 years were included for analysis. Of these, 81 patients (33%) developed the PTS. The multivariate model showed that patients who spend more than 50% of their time beneath an INR level of 2.0 are at higher risk for PTS [odds ratio (OR): 2.71, 95% CI: 1.44-5.10].
Low quality treatment with VKA, which is a common condition, is related to the occurrence of the PTS in patients with DVT. Strategies aimed at improving the quality of long-term anticoagulation might have the potential to reduce the incidence of this complication.
在接受充分治疗的深静脉血栓形成（DVT）发作患者中，约30%在2年内会发生血栓后综合征（PTS）。在使用维生素K拮抗剂（VKA）治疗期间，患者国际标准化比值（INR）在2.0至3.0之间的时间仅占60%。我们推测，在该范围以下花费大量时间的患者发生PTS的风险会增加。
研究VKA抗凝治疗质量与PTS发生风险之间的关系。
计算首次发生DVT且接受VKA治疗至少3个月的患者在治疗范围以下所花费的时间。在最长5年的随访评估中，记录PTS的体征和症状的存在情况及严重程度。
共纳入244例患者进行分析，中位随访时间为4.9年。其中，81例患者（33%）发生了PTS。多变量模型显示，INR水平低于2.0的时间超过50%的患者发生PTS的风险更高[比值比（OR）：2.71，95%置信区间（CI）：1.44 - 5.10]。
VKA治疗质量低下这一常见情况与DVT患者发生PTS有关。旨在提高长期抗凝质量的策略可能有降低这种并发症发生率的潜力。
