Yamada Shoko Merrit, Tomita Yusuke, Murakami Hideki, Nakane Makoto
Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
Yonsei Med J. 2016 Mar;57(2):388-92. doi: 10.3349/ymj.2016.57.2.388.
Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients.
Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was ≤ 11 and who was older than ≥ 60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed.
DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis.
Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.
急性神经系统疾病所致昏迷的老年患者发生深静脉血栓形成（DVT）的风险很高。本研究评估了这些患者中DVT的发生率以及早期开始治疗的有效性。
一年内共有323例因神经系统疾病入住我院病房，其中格拉斯哥昏迷量表评分≤11分且年龄≥60岁的患者43例纳入本研究。入院时及第7天检测D-二聚体，第7天行下肢超声检查。DVT阳性时开始肝素治疗，并进一步评估肺栓塞（PE）。PE阳性患者置入下腔静脉滤器。分析DVT和PE的发生率、D-二聚体值的变化以及肝素治疗的效果。
19例（44.2%）患者DVT阳性，4例（9.3%）患者PE阳性。第7天DVT阳性组D-二聚体显著升高（p＜０.０１）。缺血性疾病患者未发现DVT，而脑出血患者中66.7%、脑挫裂伤患者中53.3%的DVT呈阳性。手术是DVT的明确危险因素，比值比为5.25。所有病例经治疗后DVT和PE均消失，无患者死于血栓形成。
出血性疾病患者或接受手术的患者发生DVT的风险较高，入院后7天内开始肝素治疗是昏迷老年患者预防DVT的有效方法，且不会引起出血。
