Belcaro Gianni, Dugall Mark, Hu Shu, Feragalli Beatrice, Cotellese Roberto, Ledda Andrea, Corsi Marcello, Ricci Andrea, Ippolito Edmondo, Errichi Bruno M, Cornelli Umberto, Cesarone M Rosaria, Hosoi Morio
Irvine3 Labs, Circulation Sciences and The Nicolaides' Lab, Dipartimento Sc Med OR BIOTEC, CH-PE University, IA-PSS, Pescara, Italy -
Irvine3 Labs, Circulation Sciences and The Nicolaides' Lab, Dipartimento Sc Med OR BIOTEC, CH-PE University, IA-PSS, Pescara, Italy.
Minerva Cardioangiol. 2018 Jun;66(3):238-245. doi: 10.23736/S0026-4725.18.04618-2.
This retrospective registry study evaluated different managements on the development of post-thrombotic syndrome (PTS) and recurrent deep venous thrombosis (R-DVT). The effects of aspirin (100 mg/day), added to the "standard management" (SM) (IUA consensus), were observed in patients after a proximal DVT.
The study started after the anticoagulant period. Comparable groups used the mild-antithrombotic agent Pycnogenol® (200 mg/day), ticlopidine (250 mg/day) or sulodexide (500 ULS/day).
The groups were comparable for sex and age distribution and clinical pictures. In the SM group, 222 patients completed the follow-up (72 months). With SM, the percentage of patients with R-DVT (requiring anticoagulants) was 17.2%; 19.8% of SM patients had a PTS. In the aspirin group (202 subjects), R-DVT was observed in 14.8% of patients; 17.32% had a PTS. The reduction in R-DVT and PTS with aspirin was significant (P<0.05) vs. the SM. There was no tolerability problem in subjects using Pycnogenol® (137 patients); they had a much lower incidence of R-DVT (5.8%) and PTS (6.5%) vs. SM and aspirin (P<0.05). Ticlopidine (121 patients) reduced the incidence of R-DVT (12.4%) and PTS (19.8% of patients) (P<0.05 vs. SM). With sulodexide the incidence of R-DVT was 6.7% (P<0.05 vs. SM); the incidence of PTS was 16.6% (P<0.05 vs. SM). The combined R-DVT+PT syndrome was observed in 14.9% of subjects using SM and in 12.9% of subjects using aspirin (P<0.05 vs. SM), in 3.6% of subjects managed with Pycnogenol® (<0.05% vs. aspirin and all other managements). The incidence was 10.74% with ticlopidine and 6.7% with sulodexide (both significantly lower than SM).
Interaction between PTS and R-DVT are complex; recurrences cause more PTSs, and a post-thrombotic limb is prone to R-DVT. Aspirin, for patients that can tolerate it, reduces the occurrence of PTS and R-DVT. In addition, ticlopidine and sulodexide are effective. Pycnogenol® is the most effective and safe for R-DVT and particularly PTS. Its full range of anti-thrombotic activity is now under evaluation.
这项回顾性登记研究评估了对血栓形成后综合征（PTS）和复发性深静脉血栓形成（R-DVT）发展的不同管理方法。在近端深静脉血栓形成后的患者中，观察了添加到“标准管理”（SM）（国际血管外科学会共识）中的阿司匹林（100毫克/天）的效果。
研究在抗凝期后开始。可比组使用轻度抗血栓药物碧萝芷®（200毫克/天）、噻氯匹定（250毫克/天）或舒洛地昔（500 ULS/天）。
各研究组在性别、年龄分布和临床表现方面具有可比性。在SM组中，222例患者完成了随访（72个月）。采用SM时，R-DVT（需要抗凝治疗）患者的百分比为17.2%；19.8%的SM患者患有PTS。在阿司匹林组（202名受试者）中，14.8%的患者出现R-DVT；17.32%的患者患有PTS。与SM相比，阿司匹林使R-DVT和PTS的发生率显著降低（P<0.05）。使用碧萝芷®的受试者（137例患者）没有耐受性问题；与SM和阿司匹林相比，他们的R-DVT（5.8%）和PTS（6.5%）发生率要低得多（P<0.05）。噻氯匹定（121例患者）降低了R-DVT（12.4%）和PTS（19.8%的患者）的发生率（与SM相比P<0.05）。使用舒洛地昔时，R-DVT的发生率为6.7%（与SM相比P<0.05）；PTS的发生率为16.6%（与SM相比P<0.05）。在使用SM的受试者中，14.9%的患者出现了R-DVT+PT综合征，在使用阿司匹林的受试者中为12.9%（与SM相比P<0.05），在使用碧萝芷®治疗的受试者中为3.6%（与阿司匹林和所有其他治疗方法相比<0.05%）。噻氯匹定的发生率为10.74%，舒洛地昔为6.7%（均显著低于SM）。
PTS和R-DVT之间的相互作用很复杂；复发会导致更多的PTS，血栓形成后的肢体容易发生R-DVT。对于能够耐受的患者，阿司匹林可降低PTS和R-DVT的发生率。此外，噻氯匹定和舒洛地昔也有效。碧萝芷®对R-DVT尤其是PTS最有效且安全。其全面的抗血栓活性目前正在评估中。
