DeLaria G A, Hunter J A
Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago.
Chest. 1991 Feb;99(2):284-8. doi: 10.1378/chest.99.2.284.
We reviewed the cases of 10,638 cardiac surgical patients to determine the incidence of deep vein thrombosis (DVT) after open heart surgery (OHS). Seventy-seven patients (0.7 percent) had DVT. Group 1 included 36 patients who had DVT without pulmonary embolism (PE). Occurrence was equal in either leg. Anticoagulation with heparin and warfarin sodium (Coumadin) was employed as treatment. Extension of hospital stay was 10.8 days. Group 2 consisted of 41 patients who experienced PE 9.9 days after OHS. Sixteen patients had known DVT and were receiving heparin. In 25 patients, PE was the first event. Risk factors for PE included perioperative myocardial infarction (16 percent), atrial fibrillation (41 percent); blood type A (70 percent) (p less than 0.05), and coronary artery bypass graft (CABG) (98 percent). Twenty-four patients were treated with anti-coagulation alone. Six died of recurrent PE; mortality was 25 percent. Seventeen patients received anticoagulation plus inferior vena cava (IVC) interruption using a Hunter balloon. There were no recurrent PEs and there was one death from myocardial infarction (6 percent). Deep vein thrombosis and PE are rare complications of OHS. Routine prophylaxis with either heparin or warfarin is unnecessary. Patients with DVT, atrial fibrillation (AF), and perioperative myocardial infarction are at high risk of PE. Aggressive diagnosis to identify major venous thrombi along with anticoagulation and early consideration of IVC interruption are recommended for these patients. Patients who have undergone OHS and who have PE are at an unusually high risk for recurrent PE with death and are more safely treated with IVC interruption and anticoagulation than anticoagulation alone.
我们回顾了10638例心脏外科手术患者的病例，以确定心脏直视手术（OHS）后深静脉血栓形成（DVT）的发生率。77例患者（0.7%）发生了DVT。第1组包括36例发生DVT但无肺栓塞（PE）的患者。双侧下肢发生率相同。采用肝素和华法林钠（香豆素）进行抗凝治疗。住院时间延长了10.8天。第2组由41例在OHS后9.9天发生PE的患者组成。16例患者已知患有DVT且正在接受肝素治疗。25例患者中，PE是首发事件。PE的危险因素包括围手术期心肌梗死（16%）、房颤（41%）；A型血（70%）（p<0.05），以及冠状动脉旁路移植术（CABG）（98%）。24例患者仅接受抗凝治疗。6例死于复发性PE；死亡率为25%。17例患者接受了抗凝治疗加使用Hunter球囊进行下腔静脉（IVC）阻断。没有复发性PE，有1例死于心肌梗死（6%）。深静脉血栓形成和PE是OHS罕见的并发症。常规使用肝素或华法林进行预防没有必要。患有DVT、房颤（AF）和围手术期心肌梗死的患者发生PE的风险很高。建议对这些患者进行积极诊断以识别主要静脉血栓，并进行抗凝治疗以及早期考虑IVC阻断。接受过OHS且发生PE的患者发生复发性PE并死亡的风险异常高，与单纯抗凝治疗相比，采用IVC阻断和抗凝治疗对他们的治疗更安全。
