Vorob'eva N M, Ermolina O V, Balakhonova T V, Dobrovol'skiĭ A B, Titaeva E V, Kirienko A I, Panchenko E P
Ter Arkh. 2008;80(7):50-4.
To evaluate efficacy of 3 month therapy with warfarin in patients after an episode of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE), safety of the treatment.
26 patients after DVT/PATE aged 18-74 were treated in the hospital with non-fractionated heparin for 10-14 days followed by warfarin. The dose was selected under the control of INR up to target values 2.0-3.0. Ultrasound angioscanning of the limbs was conducted at hospitalization, on discharge, 1 and 3 months after the discharge. D-dimer was measured at discharge, 1 and 3 months after the discharge. The patients were followed up for 3 months. The following end points were considered: recurrences of deep or surface vein thrombosis, PATE recurrence, death due to PATE, hemorrhagic complications.
By ultrasound angioscanning significant positive results were not achieved. The level of D-dimer upon discharge was elevated in 18 (69.2%) patients (0.94, 0.41-1.69 mcg/ml). 3 month therapy with warfarin resulted in complete solution of all floting thrombs, achievement of recanalization of occlusive thrombosed deep vein in 20 (80%) patients, thrombosed vein number reduced from 4.0 to 3.0, p = 0.004. Deep vein thrombs disappeared only in 3 (11.5%) patients in 3 bmonths. Warfarin lowered D-dimer content to 0.23 mcg/ml (p < 0.001) in 1 month and to 0.12 mcg/ml (p < 0.001) in 3 moths after the discharge. 23 patients reached target 2.0-3.0 values and maintained them in therapeutic ranges. In DVT recurrence no PATE and PATE-related deaths were registered. Hemorrhagic complications arose in 5 patients, but they did not lead to warfarin discontinuation.
Warfarin is effective for secondary prophylaxis of DVT/PAT, but this therapy failed to solve thrombs in the deep veins in many patients.
评估华法林3个月治疗对深静脉血栓形成（DVT）和/或肺动脉血栓栓塞（PATE）发作后患者的疗效及治疗安全性。
26例年龄在18 - 74岁的DVT/PATE患者在医院接受治疗，先使用普通肝素治疗10 - 14天，随后使用华法林。剂量在国际标准化比值（INR）控制下选择，使其达到目标值2.0 - 3.0。住院时、出院时、出院后1个月和3个月进行四肢超声血管扫描。出院时、出院后1个月和3个月检测D - 二聚体。对患者随访3个月。观察以下终点指标：深静脉或浅静脉血栓复发、PATE复发、PATE导致的死亡、出血并发症。
超声血管扫描未取得显著阳性结果。出院时18例（69.2%）患者D - 二聚体水平升高（0.94，0.41 - 1.69 mcg/ml）。华法林3个月治疗使所有漂浮血栓完全溶解，20例（80%）患者闭塞性血栓形成的深静脉实现再通，血栓形成静脉数量从4.0减少至3.0，p = 0.004。3个月时仅3例（11.5%）患者深静脉血栓消失。出院后1个月华法林使D - 二聚体含量降至0.23 mcg/ml（p < 0.001），3个月时降至0.12 mcg/ml（p < 0.001）。23例患者达到目标值2.0 - 3.0并维持在治疗范围内。未记录到DVT复发、PATE及PATE相关死亡。5例患者出现出血并发症，但未导致停用华法林。
华法林对DVT/PAT的二级预防有效，但该治疗未能使许多患者深静脉内的血栓溶解。
