1University of Calgary, Calgary, Alberta, Canada.
Clin Appl Thromb Hemost. 2013 Sep;19(5):476-81. doi: 10.1177/1076029613481845. Epub 2013 Mar 20.
Patients with iliac deep vein thrombosis (DVT) have a poor prognosis and high incidence of postthrombotic syndrome (PTS). We evaluated the effect of low-molecular-weight heparin (LMWH; tinzaparin) versus usual care (tinzaparin plus warfarin for ≥12 weeks at home) in the development of PTS according to DVT location (iliac/noniliac) by retrospective analysis of the Home-LITE cohort (480 patients with proximal DVT). Patients with iliac DVT had an overall odds ratio of 0.53 (95% confidence interval [CI] 0.33, 0.83; P = .0079) for PTS (including ulcer data) in favor of tinzaparin. Patients with noniliac DVT had a similar odds ratio (0.79 [95% CI 0.67, 0.93], P = .0046) to that reported in the overall Home-LITE population (0.76 [95% CI 0.66, 0.89], P = .0004; including ulcer data), both in favor of tinzaparin. Long-term LMWH may be a suitable alternative for the prevention of PTS in patients with iliac DVT who are unlikely to undergo invasive thrombolysis.
患有髂静脉血栓形成 (DVT) 的患者预后较差,且血栓后综合征 (PTS) 的发生率较高。我们通过对 Home-LITE 队列(480 例近端 DVT 患者)的回顾性分析,根据 DVT 部位(髂/非髂)评估了低分子肝素 (LMWH;达肝素) 与常规治疗(达肝素加华法林在家中治疗≥12 周)在 PTS 发展中的效果。髂静脉 DVT 患者 PTS(包括溃疡数据)的总体优势比为 0.53(95%置信区间 [CI] 0.33, 0.83;P =.0079),有利于达肝素。非髂静脉 DVT 患者的优势比与总体 Home-LITE 人群报告的相似(0.79 [95% CI 0.67, 0.93],P =.0046),也有利于达肝素。对于不太可能接受侵入性溶栓治疗的髂静脉 DVT 患者,长期 LMWH 可能是预防 PTS 的合适替代方案。