Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, United States.
Cardiovascular Department, Mayo Clinic, Rochester, Minnesota, United States.
Thromb Haemost. 2021 Feb;121(2):216-223. doi: 10.1055/s-0040-1715646. Epub 2020 Aug 22.
The objective of this study was to characterize clinical features and outcomes among patients with calf deep vein thrombosis (DVT) limited to the muscular veins compared with axial veins.
Consecutive patients with ultrasound confirmed acute DVT involving the calf veins (January 1, 2016-August 1, 2018) were identified from the Gonda Vascular Center ultrasound database. Patients were divided into axial or muscular groups based on thrombus location. Demographics, management, and outcomes were compared.
Over the study period, there were 647 patients with calf DVT equally distributed between axial ( = 321) and muscular ( = 326) locations. Within these groups, peroneal and soleal veins were most commonly involved. Nearly all cases were provoked (97%). Synchronous pulmonary embolism (PE) were more common for axial (30.8%) compared to muscular groups (20.2%; = 0.001); nearly one-third had no pulmonary symptoms. Anticoagulation for a median of 3 months was initiated for 85.5% of both groups. Venous thromboembolism (VTE) recurrence was more common in the axial group (15.9% vs. 7.1%, = 0.0015) including more frequent DVT propagation (9.4% vs. 3.1%; = 0.0017) and PE (3.4% vs. 0.6%; = 0.0168). Major bleeding, clinically relevant nonmajor bleeding, and mortality rates did not differ between groups. Withholding anticoagulation led to more frequent thrombus propagation in the axial group (3.4% vs. 0.9%; = 0.029).
Several important features distinguish muscular from axial DVT. Axial DVT are more likely to have an associated PE and are more likely to experience recurrent VTE, particularly if anticoagulation is withheld.
本研究旨在描述局限于肌间静脉的小腿深静脉血栓形成（DVT）与轴向静脉相比的临床特征和结局。
从 Gonda 血管中心的超声数据库中确定了 2016 年 1 月 1 日至 2018 年 8 月 1 日期间经超声证实的急性小腿静脉血栓形成（DVT）的连续患者。根据血栓位置将患者分为轴向或肌间组。比较了两组患者的一般资料、治疗方法和结局。
研究期间，小腿 DVT 患者 647 例，其中轴向组（ = 321）和肌间组（ = 326）各 321 例。在这些组中，腓肠和比目鱼肌静脉最常受累。几乎所有病例均为诱因性（97%）。与肌间组（20.2%）相比，轴向组（30.8%）更常见同步性肺栓塞（PE）（ = 0.001）；近三分之一的患者没有肺部症状。两组均有 85.5%的患者接受了中位时间为 3 个月的抗凝治疗。轴向组的静脉血栓栓塞（VTE）复发更常见（15.9%比 7.1%， = 0.0015），包括更频繁的血栓扩展（9.4%比 3.1%， = 0.0017）和 PE（3.4%比 0.6%， = 0.0168）。两组之间的大出血、临床相关非大出血和死亡率无差异。轴组中，未进行抗凝治疗更易导致血栓扩展（3.4%比 0.9%， = 0.029）。
肌间和轴向 DVT 有一些重要的特征区别。轴向 DVT 更易发生相关的 PE，并且更易发生复发性 VTE，特别是在抗凝治疗被中断的情况下。
