Chen Po-Wei, Liu Ping-Yen
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Medicine (Baltimore). 2019 Jun;98(24):e16052. doi: 10.1097/MD.0000000000016052.
Postpartum deep vein thrombosis is a unique condition in diagnosis and treatment. Rivaroxaban, a novel oral anticoagulant, is indicated for acute deep vein thrombosis, but limited data have been reported for postpartum women. Catheter-directed thrombolysis is a common procedure for treating acute deep vein thrombosis, but it is rarely used for postpartum patients, especially after more than 3 months.
A 31-year-old Asian woman suffered from progressive erythematous swelling and local heat of the left lower limb after twin delivery.
Venous duplex ultrasound examination showed thrombus formation in the left femoral vein and popliteal vein with reduced compressibility. After standard treatment of novel oral anticoagulant therapy for 4 months, we observed only partial improvement of the symptoms, and the condition deteriorated after her ordinary activities.
Venography was performed and a large amount of thrombus lining from left femoral vein to left iliac vein was noted with total occluded left common iliac vein. After catheter-directed thrombolysis and balloon dilatation, better flow was regained and her symptoms improved completely after procedure.
During a 1-year follow-up without medication, the patient did not complain about leg swelling, exercise aggravation, or any other post-thrombotic symptoms.
Pregnancy seems to be a transient provoking factor for deep vein thrombosis, but it is sometimes refractory even during the postpartum period.Follow-up imaging studies should be encouraged to confirm the vessel condition, particularly for applying down-titration or discontinuation strategies of medication.Catheter-directed thrombolysis could be considered as an alternative method for postpartum iliofemoral deep vein thrombosis. Postpartum women usually have favorable functional status and lower bleeding risk.Rivaroxaban is a favorable choice for deep vein thrombosis, but its use in postpartum women is still controversial, and evidence of its effectiveness is not available. Thus, endovascular intervention can be a relatively safe therapy, in addition to anticoagulation therapy for premenopausal patients with recurrent deep vein thrombosis.
产后深静脉血栓形成在诊断和治疗方面是一种独特的病症。利伐沙班是一种新型口服抗凝剂，适用于急性深静脉血栓形成，但关于产后女性的相关数据报道有限。导管定向溶栓是治疗急性深静脉血栓形成的常见方法，但很少用于产后患者，尤其是产后3个月以上的患者。
一名31岁的亚洲女性在分娩双胞胎后出现左下肢进行性红斑肿胀和局部发热。
静脉双功超声检查显示左股静脉和腘静脉有血栓形成，可压缩性降低。在接受新型口服抗凝剂标准治疗4个月后，我们仅观察到症状部分改善，且在她日常活动后病情恶化。
进行了静脉造影，发现从左股静脉到左髂静脉有大量血栓附着，左总髂静脉完全闭塞。经过导管定向溶栓和球囊扩张后，血流恢复较好，术后她的症状完全改善。
在无药物治疗的1年随访期间，患者未抱怨腿部肿胀、运动加重或任何其他血栓形成后症状。
妊娠似乎是深静脉血栓形成的一个短暂诱发因素，但即使在产后期间有时也难以治愈。应鼓励进行后续影像学检查以确认血管状况，特别是在应用药物减量或停药策略时。导管定向溶栓可被视为产后髂股深静脉血栓形成的一种替代方法。产后女性通常具有良好的功能状态和较低的出血风险。利伐沙班是深静脉血栓形成的一个不错选择，但其在产后女性中的应用仍存在争议，且尚无其有效性的证据。因此，对于复发性深静脉血栓形成的绝经前患者，除抗凝治疗外，血管内介入治疗可能是一种相对安全的治疗方法。
