Gallus A, Jackaman J, Tillett J, Mills W, Wycherley A
Lancet. 1986 Dec 6;2(8519):1293-6. doi: 10.1016/s0140-6736(86)91431-5.
Two anticoagulant regimens, similar except for the timing of warfarin therapy, were compared in patients with clinically submassive venous thromboembolism (VTE). Warfarin was begun after 7 days of continuous intravenous heparin infusion in group L (127 patients) or within 3 days (average 1 day) of starting heparin in group S (139 patients), with similar outcomes. The frequency of symptomatic VTE recurrence during the hospital stay was 4.7% in group L and 3.6% in group S, and that of symptomless new perfusion defects 8.5% in group L and 3.9% in group S. On routine iodine-125-fibrinogen leg scanning of patients presenting with distal thrombosis (in the calf, popliteal, or distal femoral veins) 3.6% of group S but no group L patients had symptomless proximal extension. The incidence of bleeding was similar with both regimens. Outpatient follow-up showed no excess recurrent VTE in either treatment group. Early warfarin treatment significantly shortened hospital stay by an average of 3.9 days (30%) in patients admitted solely because of VTE.
在临床诊断为亚大面积静脉血栓栓塞症（VTE）的患者中，对两种抗凝方案进行了比较，这两种方案除华法林治疗的时间不同外其他方面相似。L组（127例患者）在持续静脉输注肝素7天后开始使用华法林，S组（139例患者）在开始使用肝素后3天内（平均1天）开始使用华法林，两组结果相似。住院期间有症状的VTE复发率在L组为4.7%，在S组为3.6%；无症状的新灌注缺损率在L组为8.5%，在S组为3.9%。对表现为远端血栓形成（小腿、腘静脉或股静脉远端）的患者进行常规碘-125-纤维蛋白原腿部扫描发现，S组有3.6%的患者有无症状的近端扩展，而L组无此情况。两种方案的出血发生率相似。门诊随访显示，两个治疗组的VTE复发均未增加。对于仅因VTE入院的患者，早期使用华法林治疗可使住院时间平均显著缩短3.9天（30%）。
