Park Jong Kwon, Koo Do Hoon, Yoon Doo Hwan, Lee Jeong Nyeo
Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
Ann Vasc Surg. 2016 Jul;34:119-34. doi: 10.1016/j.avsg.2015.11.038. Epub 2016 May 10.
D-dimer levels are closely related to the clinical status of deep vein thrombosis (DVT). This study aimed to investigate the factors which were associated with the normalization of D-dimer level by vitamin K antagonist (VKA) therapy, the maintenance of normal D-dimer levels for 6 months during VKA therapy, and the recurrent elevations of D-dimer above normal level after VKA withdrawal, in DVT of the legs.
The 469 consecutive patients with first-episode leg swelling were examined. All blood tests were measured from the initially sampled blood before the administration of medications.
Of the 469 patients, 288 (61.4%) showed positive D-dimer test. Radiologic examinations, including Doppler ultrasound and computed tomography venography, of the 288 patients revealed positive DVT of the legs in 135 (46.9%) patients and of these, 122 with total follow-up durations of >6 months were enrolled in this study. Linear regression analysis of 100 patients who experienced D-dimer normalization revealed initial D-dimer levels were positively correlated with D-dimer normalization time during VKA therapy (P = 0.010). Logistic regression analysis showed initial D-dimer level was negatively associated with the normalization of D-dimer levels by VKA therapy (P = 0.045), and being a woman (P = 0.005) and having lower protein C (P = 0.002) level had negative impacts on the maintenance of normal D-dimer levels for 6 months during VKA therapy. Finally, after VKA withdrawal, the recurrent elevations of D-dimer above normal level were more likely to occur in women than in men (P = 0.004).
From these observations, it is suggested that higher initial D-dimer level, lower protein C level, and female gender may be the adverse risk factors for the treatment of DVT of the legs using VKA.
D-二聚体水平与深静脉血栓形成（DVT）的临床状况密切相关。本研究旨在探讨在下肢DVT中，与维生素K拮抗剂（VKA）治疗后D-二聚体水平恢复正常、VKA治疗期间D-二聚体水平维持正常6个月以及VKA停药后D-二聚体水平反复升高至正常水平以上相关的因素。
对469例首次出现腿部肿胀的连续患者进行检查。所有血液检测均在给药前采集的初始血液样本中进行。
469例患者中，288例（61.4%）D-二聚体检测呈阳性。对这288例患者进行的包括多普勒超声和计算机断层静脉造影在内的影像学检查显示，135例（46.9%）患者下肢DVT呈阳性，其中122例总随访时间>6个月的患者纳入本研究。对100例D-二聚体恢复正常的患者进行线性回归分析显示，初始D-二聚体水平与VKA治疗期间D-二聚体恢复正常的时间呈正相关（P = 0.010）。逻辑回归分析显示，初始D-二聚体水平与VKA治疗使D-二聚体水平恢复正常呈负相关（P = 0.045），女性（P = 0.005）和蛋白C水平较低（P = 0.002）对VKA治疗期间D-二聚体水平维持正常6个月有负面影响。最后，VKA停药后，D-二聚体水平反复升高至正常水平以上的情况在女性中比男性更易发生（P = 0.004）。
从这些观察结果来看，提示较高的初始D-二聚体水平、较低的蛋白C水平和女性性别可能是使用VKA治疗下肢DVT的不良危险因素。
