Philbrick J T, Becker D M
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
Arch Intern Med. 1988 Oct;148(10):2131-8.
To determine the natural history of calf deep venous thrombosis (C-DVT), an analytic review of the 20 relevant English-language papers published since 1942 was performed. Remarkably little methodologically sound research on this subject was found. However, available evidence suggests that C-DVT propagates to the thigh in up to 20% of cases and that propagation invariably occurs before embolization. No fatal emboli were reported in patients presenting with isolated C-DVT. Traditional anticoagulation treatment with heparin sodium and warfarin sodium of symptomatic patients with C-DVT appears to prevent extension, embolization, and early recurrence. There is no convincing evidence that C-DVT leads to chronic venous insufficiency or whether the risks of anticoagulation exceed the risks of no treatment. As an option to anticoagulation, physicians may choose to follow patients with C-DVT with serial impedance plethysmography, treating only if there is evidence of proximal extension.
为了确定小腿深静脉血栓形成（C-DVT）的自然病史，我们对1942年以来发表的20篇相关英文论文进行了分析性综述。结果发现，关于这个主题的方法学上合理的研究非常少。然而，现有证据表明，高达20%的C-DVT病例会蔓延至大腿，并且蔓延总是在栓塞之前发生。在孤立性C-DVT患者中未报告有致命栓子。对有症状的C-DVT患者采用肝素钠和华法林钠进行传统抗凝治疗似乎可以预防血栓扩展、栓塞和早期复发。没有令人信服的证据表明C-DVT会导致慢性静脉功能不全，也没有证据表明抗凝治疗的风险是否超过不治疗的风险。作为抗凝治疗的一种选择，医生可以选择通过连续阻抗体积描记法对C-DVT患者进行随访，仅在有近端血栓扩展证据时才进行治疗。
