Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Blood. 2018 Nov 22;132(21):2298-2304. doi: 10.1182/blood-2018-03-836783. Epub 2018 Sep 20.
Thus far, the association between residual vein occlusion and immediate compression therapy and postthrombotic syndrome is undetermined. Therefore, we investigated whether compression therapy immediately after diagnosis of deep vein thrombosis affects the occurrence of residual vein obstruction (RVO), and whether the presence of RVO is associated with postthrombotic syndrome and recurrent venous thromboembolism. In a prespecified substudy within the IDEAL (individualized duration of elastic compression therapy against long-term duration of therapy for prevention of postthrombotic syndrome) deep vein thrombosis (DVT) study, 592 adult patients from 10 academic and nonacademic centers across The Netherlands, with objectively confirmed proximal DVT of the leg, received no compression or acute compression within 24 hours of diagnosis of DVT with either multilayer bandaging or compression hosiery (pressure, 35 mm Hg). Presence of RVO and recurrent venous thromboembolism was confirmed with compression ultrasonography and incidence of postthrombotic syndrome as a Villalta score of at least 5 at 6 and 24 months. The average time from diagnosis until assessment of RVO was 5.3 (standard deviation, 1.9) months. A significantly lower percentage of patients who did receive compression therapy immediately after DVT had RVO (46.3% vs 66.7%; odds ratio, 0.46; 95% confidence interval, 0.27-0.80; = .005). Postthrombotic syndrome was less prevalent in patients without RVO (46.0% vs 54.0%; odds ratio, 0.65; 95% confidence interval, 0.46-0.92; = .013). Recurrent venous thrombosis showed no significant association with RVO. Immediate compression should therefore be offered to all patients with acute DVT of the leg, irrespective of severity of complaints. This study was registered at ClinicalTrials.gov (NCT01429714) and the Dutch Trial registry in November 2010 (NTR2597).
迄今为止，残留静脉阻塞与即时压迫治疗和血栓后综合征之间的关联尚未确定。因此，我们研究了深静脉血栓形成（DVT）诊断后立即进行压迫治疗是否会影响残留静脉阻塞（RVO）的发生，以及 RVO 的存在是否与血栓后综合征和复发性静脉血栓栓塞有关。在 IDEAL（个体化弹性压迫治疗持续时间对预防血栓后综合征的长期治疗持续时间）深静脉血栓形成（DVT）研究的一个预设子研究中，来自荷兰 10 个学术和非学术中心的 592 名成年患者，患有腿部近端深静脉血栓形成（DVT），在诊断后 24 小时内没有接受压迫或急性压迫治疗，使用多层绷带或压缩袜（压力为 35 毫米汞柱）。通过压缩超声检查证实存在 RVO 和复发性静脉血栓栓塞，并通过 Villalta 评分在 6 个月和 24 个月时评估血栓后综合征的发生率至少为 5。从诊断到评估 RVO 的平均时间为 5.3（标准差 1.9）个月。立即接受 DVT 压迫治疗的患者中，RVO 的比例明显较低（46.3%比 66.7%；比值比，0.46；95%置信区间，0.27-0.80； =.005）。无 RVO 的患者血栓后综合征的患病率较低（46.0%比 54.0%；比值比，0.65；95%置信区间，0.46-0.92； =.013）。复发性静脉血栓形成与 RVO 无显著相关性。因此，所有腿部急性 DVT 患者，无论症状严重程度如何，都应立即给予压迫治疗。该研究在 ClinicalTrials.gov（NCT01429714）和荷兰试验注册处（NTR2597）于 2010 年 11 月注册。
