疑似深静脉血栓形成的孕妇连续压缩超声和髂静脉成像阴性后，停止抗凝治疗的安全性。
Safety of withholding anticoagulation in pregnant women with suspected deep vein thrombosis following negative serial compression ultrasound and iliac vein imaging.
机构信息
Department of Medicine, McMaster University, Hamilton, Ont.
出版信息
CMAJ. 2013 Mar 5;185(4):E194-200. doi: 10.1503/cmaj.120895. Epub 2013 Jan 14.
BACKGROUND
Compression ultrasonography performed serially over a 7-day period is recommended for the diagnosis of deep vein thrombosis in symptomatic pregnant women, but whether this approach is safe is unknown. We evaluated the safety of withholding anticoagulation from pregnant women with suspected deep vein thrombosis following negative serial compression ultrasonography and iliac vein imaging.
METHODS
Consecutive pregnant women who presented with suspected deep vein thrombosis underwent compression ultrasonography and Doppler imaging of the iliac vein of the symptomatic leg(s). Women whose initial test results were negative underwent serial testing on 2 occasions over the next 7 days. Women not diagnosed with deep vein thrombosis were followed for a minimum of 3 months for the development of symptomatic deep vein thrombosis or pulmonary embolism.
RESULTS
In total, 221 pregnant women presented with suspected deep vein thrombosis. Deep vein thrombosis was diagnosed in 16 (7.2%) women by initial compression ultrasonography and Doppler studies; none were identified as having deep vein thrombosis on serial testing. One patient with normal serial testing had a pulmonary embolism diagnosed 7 weeks later. The overall prevalence of deep vein thrombosis was 7.7% (17/221); of these, 65% (11/17) of cases were isolated to the iliofemoral veins and 12% (2/17) were isolated iliac deep vein thromboses. The incidence of venous thromboembolism during follow-up was 0.49% (95% confidence interval [CI] 0.09%-2.71%). The sensitivity of serial compression ultrasonography with Doppler imaging was 94.1% (95% CI 69.2%-99.7%), the negative predictive value was 99.5% (95% CI 96.9%-100%), and the negative likelihood ratio was 0.068 (95% CI 0.01-0.39).
INTERPRETATION
Serial compression ultrasonography with Doppler imaging of the iliac vein performed over a 7-day period excludes deep-vein thrombosis in symptomatic pregnant women.
背景
对于有症状的孕妇，推荐在 7 天内连续进行压缩超声检查以诊断深静脉血栓形成，但这种方法是否安全尚不清楚。我们评估了在连续压缩超声和髂静脉成像阴性后对疑似深静脉血栓形成的孕妇不抗凝的安全性。
方法
连续出现疑似深静脉血栓形成的孕妇进行症状下肢的压缩超声和髂静脉多普勒成像。初次检查结果阴性的女性在接下来的 7 天内进行 2 次连续检查。未诊断为深静脉血栓形成的女性至少随访 3 个月，以观察有无症状性深静脉血栓形成或肺栓塞发生。
结果
总共 221 名孕妇出现疑似深静脉血栓形成。16 名（7.2%）孕妇通过初次压缩超声和多普勒检查诊断为深静脉血栓形成；连续检查均未发现深静脉血栓形成。1 名初次检查正常的患者在 7 周后被诊断为肺栓塞。深静脉血栓形成的总体患病率为 7.7%（17/221）；其中，65%（11/17）的病例局限于髂股静脉，12%（2/17）的病例为孤立性髂内深静脉血栓形成。随访期间静脉血栓栓塞的发生率为 0.49%（95%置信区间 [CI]，0.09%-2.71%）。连续压缩超声和髂静脉多普勒成像的敏感性为 94.1%（95% CI，69.2%-99.7%），阴性预测值为 99.5%（95% CI，96.9%-100%），阴性似然比为 0.068（95% CI，0.01-0.39）。
结论
在 7 天内连续进行髂静脉压缩超声和多普勒成像可排除有症状孕妇的深静脉血栓形成。
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