Mlaco Akif, Mlaco Nejra, Bejtovic Demir, Dzubur Alen, Spuzic Muhamed
Department of Angiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Mater Sociomed. 2019 Jun;31(2):84-87. doi: 10.5455/msm.2019.31.84-87.
Venous thromboembolism (VTE) consists of two entities, deep venous thrombosis (DVT), and its complication, pulmonary embolism (PE). The main therapeutic goal is the prevention of this complication.
The aim of the study was to present epidemiological data of patients with the diagnosis of deep venous thrombosis, with regard to the location of thrombosis, the value of fibrinogen and D-dimer in relation to the sex of the patients, the presentation of therapeutic modality, with the presentation of PE and treatment outcomes.
The study has a retrospective and observational feature, covering the period from 2008 to 2017, and included 1154 patients with the diagnosis of deep venous thrombosis as a basic criterion for inclusion. Data on sex, age, diagnosis with thrombosis localization, hospitalization duration, administered therapy, D-dimer and fibrinogen values, pulmonary thromboembolism and mortality were collected.
The deep venous thrombosis was mostly located at the lower limbs - in 1079 respondents (93.5%), then at the upper limbs in 65 (5.63%) cases. The left side is more represented (58.9%) than the right (40.3%), which is statistically significant (χ=40.03, p<0.005), while 0.9% of patients had DVT bilaterally. At the lower limbs is the most common iliac thrombosis, represented in 47% of thrombosis cases at the lower limbs. Subclavian axillary thrombosis has been reported in ¾ cases at the upper limbs. The mean fibrinogen concentration in all respondents is 5.2 mg/L, for men 5.0 mg/L and for women 5.3 mg/L, above the reference values (1.8-3.8 g/L). The mean value of D-dimer was 7.33 mg/L for all respondents, 8.46 mg/L for women and 6.5 mg/L for men, which was high above the reference limit (0.55 mg/L). From baseline, 88 (7.6%) of respondents had proven/high-grade pulmonary thromboembolism as a DVT complication in the observed period. Pearson correlation established a positive correlation between lethal outcome and patient age, r=0.13, p<0.005, followed by a higher incidence of lethal outcome after DVT in older patients.
The incidence of venous thromboembolism is approximately equal among the genders, and increases with the age of the patients, especially in men. Fibrinogen and D-dimer values in hospitalized patients are higher than the reference, in both cases more among women. Multidisciplinary approach to patients, in cooperation with angiologists, pulmonologists, cardiologists and nuclear medicine specialists is an imperative. The development of a state-level registry that would follow the incidence of deep venous thrombosis, with reference to risk factors, is imperative and necessary in planning of community health system.
静脉血栓栓塞症（VTE）包括两种情况，即深静脉血栓形成（DVT）及其并发症肺栓塞（PE）。主要治疗目标是预防这种并发症。
本研究的目的是呈现深静脉血栓形成患者的流行病学数据，涉及血栓形成部位、纤维蛋白原和D - 二聚体的值与患者性别的关系、治疗方式的呈现、肺栓塞的情况及治疗结果。
本研究具有回顾性和观察性特点，涵盖2008年至2017年期间，纳入1154例以深静脉血栓形成为基本纳入标准的患者。收集了关于性别、年龄、血栓形成部位诊断、住院时间、所给予的治疗、D - 二聚体和纤维蛋白原值、肺血栓栓塞和死亡率的数据。
深静脉血栓形成大多位于下肢——1079例受访者（93.5%），上肢有65例（5.63%）。左侧比右侧更常见（58.9%对40.3%），具有统计学意义（χ = 40.03，p < 0.005），而0.9%的患者双侧有深静脉血栓形成。下肢最常见的是髂静脉血栓形成，占下肢血栓形成病例的47%。上肢¾的病例报告有锁骨下腋静脉血栓形成。所有受访者的平均纤维蛋白原浓度为5.2 mg/L，男性为5.0 mg/L，女性为5.3 mg/L，高于参考值（1.8 - 3.8 g/L）。所有受访者的D - 二聚体平均值为7.33 mg/L，女性为8.46 mg/L，男性为6.5 mg/L，远高于参考限值（0.55 mg/L）。从基线开始，88例（7.6%）受访者在观察期内被证实/发生高危肺血栓栓塞作为深静脉血栓形成的并发症。Pearson相关性分析显示死亡结局与患者年龄呈正相关，r = 0.13，p < 0.005，老年患者深静脉血栓形成后死亡结局发生率更高。
静脉血栓栓塞症的发病率在男女之间大致相等，并随患者年龄增加而上升，尤其是男性。住院患者的纤维蛋白原和D - 二聚体值高于参考值，两种情况在女性中更为明显。与血管病专家、肺科医生、心脏病专家和核医学专家合作，对患者采取多学科方法势在必行。建立一个国家级登记系统以跟踪深静脉血栓形成的发病率及相关危险因素，对于社区卫生系统规划至关重要且必要。
