Vítovec M, Golán L, Roztocil K, Linhart A
2nd Medical Department--Clinical Department of Cardiology and Angiology, First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic.
Vasa. 2009 Aug;38(3):238-44. doi: 10.1024/0301-1526.38.3.238.
The aim of the study was to assess the regression rate of persistent echogenic masses in patients with idiopathic deep venous thrombosis (DVT) who were after initial 6 months randomized to long-term anticoagulation treatment or to discontinuation of anticoagulation.
We followed 168 patients with idiopathic DVT for two years since diagnosis. After 6 months of standard therapy (heparin/LMWH, warfarin with target INR 2-3) we randomized patients with persistent echogenic masses of over 20% of venous diameter to either discontinuation of warfarin or to continuation of warfarin for another 6 months. We evaluated the size of thrombotic masses with duplex ultrasound.
After 6 months of standard therapy complete regression was observed in 69 patients while in 99 patients echogenic masses persisted, with 71 patients maintaining an obstruction of at least 20% of venous cross-sectional area. 52 patients were randomized. 27 patients continued warfarin therapy and in 25 patients warfarin was discontinued. After discontinuation of warfarin a further trend to regression was seen in both groups. A significant difference in regression of thrombotic masses between the 6th and 12th month of follow up was seen in patients continuing to receive warfarin, both within the popliteal vein (2.81 +/- 1.56 vs. 2.10 +/- 1.67 mm, p < 0.05) and the femoral vein (3.95 +/- 2.74 vs. 2.30 +/- 1.34 mm, p < 0.05).
After 6 months of DVT treatment persistent echogenic masses can be found in almost two thirds of patients. Even after discontinuation of anticoagulation treatment echogenic masses further regress. However, the rate of regression in patients with deep venous thrombosis between the 6th and 12th month was greater in patients randomized to continue warfarin during this period than in patients without anticoagulation.
本研究的目的是评估特发性深静脉血栓形成（DVT）患者中持续性强回声团块的消退率，这些患者在最初6个月后被随机分为长期抗凝治疗组或停止抗凝治疗组。
自诊断起，我们对168例特发性DVT患者进行了两年的随访。在6个月的标准治疗（肝素/低分子肝素、目标国际标准化比值（INR）为2 - 3的华法林）后，我们将静脉直径超过20%的持续性强回声团块患者随机分为停用华法林组或继续使用华法林6个月组。我们用双功超声评估血栓团块的大小。
标准治疗6个月后，69例患者的血栓完全消退，而99例患者的强回声团块持续存在，其中71例患者静脉横截面积阻塞至少20%。52例患者被随机分组。27例患者继续华法林治疗，25例患者停用华法林。停用华法林后，两组均出现进一步的消退趋势。在继续接受华法林治疗的患者中，随访第6个月和第12个月时，腘静脉（2.81±1.56 vs. 2.10±1.67 mm，p < 0.05）和股静脉（3.95±2.74 vs. 2.30±1.34 mm，p < 0.05）内血栓团块的消退存在显著差异。
DVT治疗6个月后，近三分之二的患者可发现持续性强回声团块。即使在停止抗凝治疗后，强回声团块仍会进一步消退。然而，在此期间随机分组继续使用华法林的深静脉血栓形成患者，其第6个月至第12个月的消退率高于未接受抗凝治疗的患者。
