Guarnera G, Abeni D, Antignani P L, Apollonio A, Conti F, Mollo P L, Murgiano A, Ofria F, Ruggeri M
IDI-IRCCS, Rome, Italy -
Int Angiol. 2014 Dec;33(6):560-4. Epub 2014 Jun 19.
No study of strong methodology could be found to resolve the controversy of optimal treatment of distal deep venous thrombosis (DDVT). Some inconclusive evidence exists on two approaches to care: anticoagulants and compression therapy or compression therapy and Duplex scanning monitoring. Different studies report propagation to popliteal vein in 8% of patients without anticoagulant treatment, while a complete thrombus resolution within 4 weeks occurred in 20% of patients. We report data of a study conducted in patients affected by DDVT and treated with nadroparin administered once daily in association with compression therapy.
One hundred and ten patients with DDVT of the gastrocnemius or tibial veins, assessed by Duplex scanning, were enrolled in 8 clinical centres of the Lazio Region. At baseline, patient demographics, medical history (including risk factors for DDVT), circumferences of both calves and ankles, and a VAS-pain scale were recorded. At 7 and 28 days from baseline, patients were re-assessed by Duplex scanning, calves and ankles circumferences and VAS-pain were measured, and the patients were asked about possible side effects.
At the end of the study period, no propagation to the popliteal vein was observed, and no side effects were reported. Overall, the calf circumference in the affected leg significantly decreased from baseline (38.1 cm) to week 1 (37.1 cm), and to week 4 (35.7 cm). Also the VAS-pain scores significantly decreased during the study - the observed means were 58.4, 30.7, and 12.7 at the three visits, respectively. The percentage of partial recanalization of tibial DVT at 7 days was lower than gastrocnemius DVT (31.6% vs. 59.8%) whereas the percentage of total recanalization at 28 days was comparable (52.6% vs. 59.8%). Complete recanalization occurred in 56.4% of all patients.
Our study suggests that anticoagulant treatment, associated with compression therapy, is safe and causes clinical improvement (as assessed by calf measurements) and pain relief. Overall complete resolution (56.4%) is significantly higher than in untreated patients (20%). Such results, together with the already reported higher satisfaction of patients for the once-daily administration regimen, should be considered as a viable option for the treatment of DDVT.
尚未发现有强有力的方法学研究能够解决远端深静脉血栓形成（DDVT）最佳治疗方法的争议。关于两种治疗方法存在一些不确定的证据：抗凝治疗与压迫治疗，或压迫治疗与双功超声扫描监测。不同研究报告称，在未接受抗凝治疗的患者中，8%的患者血栓蔓延至腘静脉，而20%的患者在4周内血栓完全溶解。我们报告了一项针对DDVT患者的研究数据，这些患者接受了每日一次的那屈肝素联合压迫治疗。
通过双功超声扫描评估，110例腓肠肌或胫静脉DDVT患者被纳入拉齐奥地区的8个临床中心。在基线时，记录患者的人口统计学资料、病史（包括DDVT的危险因素）、双侧小腿和脚踝的周长以及视觉模拟疼痛量表评分。在基线后的第7天和第28天，通过双功超声扫描对患者进行重新评估，测量小腿和脚踝的周长以及视觉模拟疼痛量表评分，并询问患者是否有任何副作用。
在研究期结束时，未观察到血栓蔓延至腘静脉，也未报告有副作用。总体而言，患侧小腿周长从基线时的（38.1厘米）显著降至第1周时的（37.1厘米）和第4周时的（35.7厘米）。在研究期间，视觉模拟疼痛量表评分也显著降低——三次就诊时观察到的平均值分别为58.4、30.7和12.7。在第7天时，胫静脉DVT部分再通的百分比低于腓肠肌DVT（31.6%对59.8%），而在第28天时完全再通的百分比相当（52.6%对59.8%）。所有患者中有56.4%实现了完全再通。
我们的研究表明，抗凝治疗联合压迫治疗是安全的，并且能带来临床改善（通过小腿测量评估）和疼痛缓解。总体完全溶解率（56.4%）显著高于未治疗患者（20%）。这些结果，连同已报告的患者对每日一次给药方案更高的满意度，应被视为DDVT治疗的一个可行选择。
