Department of Internal Medicine, Montpellier University Hospital, and Research unit EA 2992, University Montpellier 1, Montpellier, France.
J Thromb Haemost. 2012 Jun;10(6):1004-11. doi: 10.1111/j.1538-7836.2012.04704.x.
The management strategies for symptomatic isolated superficial vein thrombosis (SVT) (without concomitant deep vein thrombosis [DVT] or pulmonary embolism [PE]) have yet to achieve widespread consensus. Concerns have been raised regarding the usefulness of prescribing anticoagulant treatments to all patients with isolated SVT. Determining the isolated SVT subgroups who have the highest risks of venous thromboembolism (VTE) recurrence (composite of DVT, PE, and new SVT) may facilitate the identification of patients who are likely to benefit from anticoagulant treatment.
We performed a pooled analysis on individual data from two observational, multicenter, prospective studies, to determine predictors for VTE recurrence and their impact in an unselected population of symptomatic isolated SVT patients.
One thousand and seventy-four cases of symptomatic isolated SVT were followed up at 3 months. VTE recurrence was observed in 3.9% of the patients; 16.2% of the patients did not receive anticoagulants, and 0.6% experienced a VTE recurrence. Cancer, personal history of VTE and saphenofemoral/popliteal involvement significantly increased the risk of subsequent VTE or DVT/PE in univariate analyses. Only male sex significantly increased the risk of VTE or DVT/PE recurrence in multivariate analyses. Twelve percent of the patients had cancer or saphenofemoral junction involvement, and were at higher risk of DVT/PE recurrence than patients without those characteristics (4.7% vs. 1.9%, P= 0.06).
In patients with symptomatic SVT, only male sex significantly and independently increased the risk of VTE recurrence. Cancer or saphenofemoral junction involvement defined a population at high risk for deep VTE recurrence. Some SVTs might be safely managed without anticoagulants.
有症状的孤立性浅静脉血栓形成（SVT）（无伴发深静脉血栓形成[DVT]或肺栓塞[PE]）的治疗策略尚未达成广泛共识。有人担心，给所有孤立性 SVT 患者开具抗凝治疗的方法是否有用。确定孤立性 SVT 亚组中静脉血栓栓塞（VTE）复发（DVT、PE 和新 SVT 的复合事件）风险最高的患者，可能有助于识别可能从抗凝治疗中获益的患者。
我们对两项观察性、多中心、前瞻性研究的个体数据进行了汇总分析，以确定 VTE 复发的预测因素及其在症状性孤立性 SVT 患者未选择人群中的影响。
1074 例有症状的孤立性 SVT 患者在 3 个月时进行了随访。3.9%的患者发生 VTE 复发；16.2%的患者未接受抗凝治疗，0.6%的患者发生 VTE 复发。在单变量分析中，癌症、个人 VTE 史和隐股/腘静脉受累显著增加了随后 VTE 或 DVT/PE 的风险。仅男性在多变量分析中显著增加了 VTE 或 DVT/PE 复发的风险。12%的患者有癌症或隐股交界受累，与无这些特征的患者相比，DVT/PE 复发风险更高（4.7%比 1.9%，P=0.06）。
在有症状的 SVT 患者中，只有男性显著且独立地增加了 VTE 复发的风险。癌症或隐股交界受累定义了深静脉血栓形成复发风险高的人群。一些 SVT 可能无需抗凝治疗即可安全处理。
