Imperial College Surgical Society, Imperial College School of Medicine, London, United Kingdom; Faculty of Medicine, Imperial College London, London, United Kingdom.
Imperial College Surgical Society, Imperial College School of Medicine, London, United Kingdom; Faculty of Medicine, Imperial College London, London, United Kingdom.
J Vasc Surg Venous Lymphat Disord. 2020 Mar;8(2):182-186. doi: 10.1016/j.jvsv.2019.04.011. Epub 2019 Jul 18.
Post-thrombotic syndrome is a common complication of iliofemoral deep venous thrombosis (IFDVT). Existing evidence and National Institute for Health and Care Excellence guidelines suggest that this can be reduced by prompt thrombolytic therapy or thrombectomy. We aimed to evaluate the characteristics of IFDVT patients and to identify whether patients are being offered the recommended treatment pathway.
A multicenter cross-sectional study was conducted across eight hospital sites in the North West London region, of which two were hub hospitals in their local vascular service networks. Patients with proximal DVT were identified using International Classification of Diseases, Tenth Revision coding during a 1-year period. Data on demographics, diagnostic methods used, interventions, and referrals were extracted from electronic and paper medical records.
During the study period, 132 patients with IFDVT were identified (mean age, 59.4 years; 55% female); 75% of these patients had an IFDVT. In this cohort, the biggest predisposing factors were previous DVT (n = 35), malignant disease (n = 35), and immobility (n = 20). In total, 104 patients were administered anticoagulation, and 88 of these patients received anticoagulation within 24 hours. The cases of 45 patients were either discussed with or promptly referred to a vascular service, after which 20 patients were treated solely with anticoagulation, whereas 20 patients received thrombolysis of varying methods.
A significant proportion (56%) of symptomatic IFDVT patients are not being appropriately referred to or discussed with vascular services. Of these, 43% would have been eligible for consideration of early thrombus removal. Adherence to the National Institute for Health and Care Excellence guidelines could be improved by increasing awareness among emergency department colleagues.
血栓后综合征是髂股深静脉血栓形成（IFDVT）的常见并发症。现有证据和英国国家卫生与保健优化研究所指南表明，通过及时溶栓治疗或血栓切除术可以减少这种情况。我们旨在评估 IFDVT 患者的特征，并确定患者是否接受了推荐的治疗方案。
本研究在英国西北部伦敦地区的 8 家医院进行了一项多中心横断面研究，其中 2 家医院是其所在地区血管服务网络的枢纽医院。在为期 1 年的时间内，通过国际疾病分类第十版编码识别出近端深静脉血栓形成患者。从电子病历和纸质病历中提取人口统计学、使用的诊断方法、干预措施和转介数据。
在研究期间，共发现 132 例 IFDVT 患者（平均年龄 59.4 岁；55%为女性）；其中 75%的患者患有 IFDVT。在这组患者中，最大的致病因素是先前的 DVT（n=35）、恶性肿瘤（n=35）和长期卧床（n=20）。共有 104 例患者接受抗凝治疗，其中 88 例患者在 24 小时内接受抗凝治疗。有 45 例患者的病例与血管科医生进行了讨论或立即转介，其中 20 例患者仅接受抗凝治疗，而 20 例患者接受了不同方法的溶栓治疗。
相当一部分（56%）有症状的 IFDVT 患者没有被适当转介或与血管科医生讨论。其中 43%的患者有资格考虑早期血栓清除。通过提高急诊科同事的认识，可以提高对英国国家卫生与保健优化研究所指南的依从性。
