低分子量肝素在下肢深静脉血栓导管直接溶栓治疗中抗凝的可行性。
Feasibility of anticoagulation using low molecular-weight heparin during catheter-directed thrombolysis for lower extremity deep venous thrombosis.
作者信息
Li Yonghui, Wang Junwei, He Rongzhou, Zheng Junmeng, Chen Zhibo, Yao Chen, Huang Kai
机构信息
Department of Cardiovascular Surgery, the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510080, China.
Department of Vascular Surgery, the Second Xiangya Hospital of Central South University, 139 Renming Middle Road, Changsha, 410011, China.
出版信息
Thromb J. 2021 Jan 28;19(1):6. doi: 10.1186/s12959-021-00260-3.
BACKGROUND
The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular-weight heparin (LMWH) during CDT for DVT.
METHODS
The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.
RESULTS
A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) × 10 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) × 10 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (> 90%) and partial thrombolysis (50 ~ 90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications.
CONCLUSIONS
Anticoagulation therapy using low molecular-weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.
背景
导管定向溶栓（CDT）治疗深静脉血栓形成（DVT）期间的最佳抗凝方案尚不清楚。本研究旨在评估低分子肝素（LMWH）在CDT治疗DVT期间进行抗凝治疗的可行性。
方法
回顾性收集并分析过去六年中接受CDT治疗的DVT患者的临床资料。根据LMWH剂量将患者分为治疗剂量抗凝（TPDA）组和亚治疗剂量抗凝（亚TPDA）组。
结果
共纳入61例患者，累及61条肢体。急性和亚急性DVT患者分别为39例（63.9%）和22例（36.1%）。34例（55.7%）患者血栓累及髂静脉。38例（62.3%）患者置入下腔静脉滤器。术中，分别有9例（14.8%）、4例（6.6%）和1例（1.6%）患者接受了辅助球囊、支架和血栓切除术。20例（32.8%）患者接受TPDA治疗，41例（67.2%）患者接受亚TPDA治疗。尿激酶中位输注速率为2.5（0.83至5）×10⁵U/h。中位输注持续时间为4（2至14）天，尿激酶中位输注剂量为2.4（0.6至10.80）×10⁵U。CDT期间，观察到5例（8.2%）轻微出血病例，无需输血。未发生大出血、症状性肺栓塞或死亡。56例（91.8%）患者实现了完全（>90%）和部分溶栓（50%至90%）。与亚TPDA组相比，TPDA组在基线特征、临床改善、溶栓结果和并发症方面无显著差异。
结论
在CDT期间以低输注速率使用低分子肝素治疗DVT的抗凝治疗可能是可行和安全的。亚治疗剂量抗凝和治疗剂量可用于CDT，临床结局和出血并发症相似。
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