Calligaro K D, Bergen W S, Haut M J, Savarese R P, DeLaurentis D A
Department of Medicine, Pennsylvania Hospital/University of Pennsylvania School of Medicine, Philadelphia.
Ann Vasc Surg. 1991 Mar;5(2):186-9. doi: 10.1007/BF02016754.
Thirty patients with Stage III/IV cancer and thromboembolic complications between 1987-89 were reviewed. Twelve patients had a deep venous thrombosis proximal to the calf diagnosed by duplex scanning or contrast venography, 15 patients had a pulmonary embolism diagnosed by a high-probability pulmonary ventilation/perfusion scan or arteriogram, and three patients had both deep vein thrombosis and pulmonary embolism. Patients were treated primarily with anticoagulation (Group A = 20 patients) or a Greenfield filter (Group B = 10 patients). Seventy-five percent (15/20) of the Group A patients developed 19 bleeding or thrombosis-related complications: major bleeding (7), recurrent deep venous thrombosis/pulmonary embolism (4), inability to attain consistent therapeutic anticoagulation levels (3), heparin-induced thrombocytopenia (3), or progression of deep vein thrombosis (2). A Greenfield filter was eventually placed in 10 (50%) of the Group A patients without complications. Thirty percent (3/10) of the Group B patients developed progression of deep vein thrombosis that required anticoagulation. One other Group B patient died due to a guidewire-induced arrhythmia. Although patients with advanced cancers and venous thromboembolic disease have a high complication rate with either treatment, initial treatment with a Greenfield filter appears more definitive. Anticoagulation should be reserved for patients with progressive, symptomatic deep vein thromboses after placement of a filter.
对1987年至1989年间30例患有III/IV期癌症并伴有血栓栓塞并发症的患者进行了回顾性研究。12例患者经双功扫描或静脉造影诊断为小腿近端深静脉血栓形成，15例患者经高概率肺通气/灌注扫描或动脉造影诊断为肺栓塞，3例患者同时患有深静脉血栓形成和肺栓塞。患者主要接受抗凝治疗（A组=20例患者）或置入格林菲尔德滤器（B组=10例患者）。A组患者中有75%（15/20）发生了19例与出血或血栓形成相关的并发症：大出血（7例）、复发性深静脉血栓形成/肺栓塞（4例）、无法达到稳定的治疗性抗凝水平（3例）、肝素诱导的血小板减少症（3例）或深静脉血栓形成进展（2例）。最终，10例（50%）A组患者置入了格林菲尔德滤器，且无并发症发生。B组患者中有30%（3/10）发生了深静脉血栓形成进展，需要进行抗凝治疗。B组的另1例患者因导丝诱发的心律失常死亡。尽管晚期癌症和静脉血栓栓塞疾病患者无论采用哪种治疗方法并发症发生率都很高，但初始治疗采用格林菲尔德滤器似乎更具决定性。抗凝治疗应保留给滤器置入后出现进行性、有症状的深静脉血栓形成的患者。
