Sarker S H, Miraj A K, Hossain M A, Aftabuddin M
Dr Md Sanaul Hoque Sarker, MS Phase A Student, Department of Cardiovascular and Thoracic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Mymensingh Med J. 2017 Jul;26(3):689-693.
Deep vein thrombosis is an alarming medical emergency. Deep vein thrombosis or deep venous thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein predominantly in the legs. Post-Coronary Artery Bypass Grafting deep vein thrombosis is a very rare medical condition relatively in Asian. Approximately 80% of deep vein thrombosis (DVTs) is clinically asymptomatic, 20% of those that actually demonstrate signs and symptoms can be easily confused with symptoms of other commonly presenting musculoskeletal disorders. Proper medical management can reduce patient's morbidity and further burden. A 50 years old diabetic Post-Coronary Artery Bypass Grafting gentleman had been suffering for left leg swelling, high grade fever and calf muscle pain for 5 days. He had absent Arteria Dorsalis Paedis pulse on left foot, Positive Homan sign and Wells score is 7. His left leg was hugely swelled. He had normal leg hair distribution. Duplex study of Left Leg-Deep Vein Thrombosis in left lower limb (Popliteal segment) with sign of recanalization. He is also a patient of anemia of chronic disease due to hemorrhoid. Several investigations have done to find the cause of his chronic anemia. His treatment was meticulous with complete bed rest, elevation of left lower limb, heparinization, oralrivaroxaban. He had rapid recovery following treatment. Post-Coronary Artery Bypass Grafting patient should be given post-operative enoxaparin (Low molecular weight Heparin) or Heparin for 3-5 days. Early diagnosis of the disease condition reduces morbidity. Combined treatment with Rivaroxaban and Heparin is of great clinical value and outcome in a case of Post-Coronary Artery Bypass Grafting Deep Vein Thrombosis patient.
深静脉血栓形成是一种令人担忧的医疗急症。深静脉血栓形成或深静脉血栓（DVT）是主要在腿部深静脉内形成血凝块（血栓）。冠状动脉搭桥术后深静脉血栓形成在亚洲相对是一种非常罕见的病症。大约80%的深静脉血栓（DVT）在临床上无症状，20%有实际体征和症状的患者容易与其他常见的肌肉骨骼疾病症状相混淆。恰当的医疗管理可以降低患者的发病率和进一步的负担。一位50岁的冠状动脉搭桥术后糖尿病男性患者，左腿肿胀、高热和小腿肌肉疼痛5天。他左脚足背动脉搏动消失，霍曼征阳性，韦尔斯评分为7分。他的左腿肿胀严重。他的腿部毛发分布正常。对左下肢（腘静脉段）进行的左腿深静脉血栓双功超声检查显示有再通迹象。他也是一名因痔疮导致慢性病贫血的患者。已经进行了多项检查以查找他慢性贫血的原因。对他的治疗非常细致，包括完全卧床休息、抬高左下肢、肝素化、口服利伐沙班。治疗后他恢复迅速。冠状动脉搭桥术后患者应术后给予依诺肝素（低分子量肝素）或肝素3 - 5天。疾病的早期诊断可降低发病率。对于冠状动脉搭桥术后深静脉血栓形成患者，利伐沙班和肝素联合治疗具有很大的临床价值和良好的治疗效果。
