深静脉血栓形成急性期的D-二聚体、FVIII与血栓负荷与血栓后综合征风险的关系
D-dimer, FVIII and thrombotic burden in the acute phase of deep vein thrombosis in relation to the risk of post-thrombotic syndrome.
作者信息
Sartori Michelangelo, Favaretto Elisabetta, Cini Michela, Legnani Cristina, Palareti Gualtiero, Cosmi Benilde
机构信息
Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
出版信息
Thromb Res. 2014 Aug;134(2):320-5. doi: 10.1016/j.thromres.2014.05.043. Epub 2014 Jun 8.
BACKGROUND
Post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT), but few data are available on the risk factors for PTS.
AIMS
To assess whether the time-course of D-dimer, FVIII, and thrombotic burden are related to PTS development.
METHODS
Patients (n=59) with proximal DVT of the lower limbs (age 64; range:20-88years; male 56%) were enrolled on the day of diagnosis (D0) and all received heparin for 5-7days, overlapped and followed by vitamin K antagonists (VKA) for 3months. Whole-leg compression ultrasound examination was conducted on D0 and 7 (D7), 30 (D30), and 90 (D90) days afterwards, when blood samples were also taken for D-dimer (STA Liatest) and FVIII (chromogenic assay) testing. Thrombotic burden was defined at each time point according to a score, which considered thrombosis extent and occlusion degree. Villalta score was evaluated at D30, D90, and D180.
RESULTS
At D90, 12 patients developed PTS (Villalta score ≥5) and the median Villalta score was 1 (IQR 0.3-3.0) and was not correlated with either D-dimer or FVIIII time course. At D180, 13 patients had PTS and they had similar thrombotic score at D0, D30 to those without PTS, but higher at D90 (7.6±5.1 vs. 3.2±3.6; p=0.011). Thrombotic score at D90 was correlated with Villalta score at D90 (rho=0.374, p=0.009) and at D180 (rho=0.436, p=0.006).
CONCLUSIONS
Thrombotic burden after 90days of VKA is correlated with PTS.
背景
血栓形成后综合征（PTS）是深静脉血栓形成（DVT）最常见的并发症，但关于PTS危险因素的数据很少。
目的
评估D-二聚体、FVIII和血栓负荷的时间进程是否与PTS的发生有关。
方法
纳入59例下肢近端DVT患者（年龄64岁；范围：20 - 88岁；男性占56%），在诊断当天（D0）入组，所有患者均接受肝素治疗5 - 7天，之后重叠使用并继以维生素K拮抗剂（VKA）治疗3个月。在D0、7天（D7）、30天（D30）和90天（D90）进行全腿压迫超声检查，同时采集血样进行D-二聚体（STA Liatest法）和FVIII（发色底物法）检测。根据一个考虑血栓形成范围和阻塞程度的评分在每个时间点定义血栓负荷。在D30、D90和D180评估Villalta评分。
结果
在D90时，12例患者发生PTS（Villalta评分≥5），Villalta评分中位数为1（四分位间距0.3 - 3.0），且与D-二聚体或FVIII的时间进程均无相关性。在D180时，13例患者发生PTS，他们在D0、D30时的血栓评分与未发生PTS的患者相似，但在D90时更高（7.6±5.1对3.2±3.6；p = 0.011）。D90时的血栓评分与D90时的Villalta评分相关（rho = 0.374，p = 0.009）以及与D180时的Villalta评分相关（rho = 0.436，p = 0.006）。
结论
VKA治疗90天后的血栓负荷与PTS相关。
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