Li Yuping, Ding Junrong, Shen Lei, Yang Jian, Wang Haifeng, Zhou Yiming, Jiang Gening, Zhu Yuming, Wang Yin
Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Front Surg. 2021 Apr 28;8:671165. doi: 10.3389/fsurg.2021.671165. eCollection 2021.
Isolated distal deep vein thrombosis (IDDVT) accounts for ~50% of all patients diagnosed with deep venous thrombosis (DVT), but the diagnosis and optimal management of IDDVT remains unclear and controversial. The aim of this study was to explore potential risk factors and predictors of IDDVT, and to evaluate different strategies of anticoagulation therapy. A total of 310 consecutive patients after thoracic surgery, who underwent whole-leg ultrasonography as well as routine measurements of D-dimer levels before and after surgery were evaluated. The general clinical data, anticoagulant therapy, pre- and postoperative D-dimer levels were collected. Differences between IDDVT, DVT and non-DVT groups were calculated. Logistic regression analysis was used to analyze risk factors of postoperative IDDVT. Age and postoperative D-dimer levels were significantly higher in IDDVT group than in non DVT group ( = 0.0053 and < 0.001, respectively). Logistic regression analysis showed that postoperative D-dimer level was a significant independent predictor of IDDVT even when adjusted for age and operation method ( = 0.0003). There were no significant side effects associated with both full-dose and half-dose anticoagulation regimens. Half-dose therapy was associated with a significant decrease in the requirement for anticoagulation medications after discharge ( = 0.0002). Age and D-dimer levels after surgery are strong predictors of IDDVT following thoracic surgery. Half-dose therapeutic anticoagulation has the same efficiency in preventing IDDVT progression, is not associated with any additional risks of adverse effects compared to a full-dose regimen, and may be adopted for treating IDDVT patients after thoracic surgery.
孤立性远端深静脉血栓形成（IDDVT）占所有诊断为深静脉血栓形成（DVT）患者的约50%，但IDDVT的诊断和最佳管理仍不明确且存在争议。本研究的目的是探讨IDDVT的潜在危险因素和预测因素，并评估不同的抗凝治疗策略。对310例连续接受胸外科手术的患者进行了评估，这些患者在手术前后均接受了全腿超声检查以及D-二聚体水平的常规测量。收集了一般临床资料、抗凝治疗情况、术前和术后D-二聚体水平。计算了IDDVT组、DVT组和非DVT组之间的差异。采用逻辑回归分析来分析术后IDDVT的危险因素。IDDVT组的年龄和术后D-二聚体水平显著高于非DVT组（分别为 = 0.0053和 < 0.001）。逻辑回归分析表明，即使在调整年龄和手术方法后，术后D-二聚体水平仍是IDDVT的显著独立预测因素（ = 0.0003）。全剂量和半剂量抗凝方案均未出现显著副作用。半剂量治疗与出院后抗凝药物需求的显著减少相关（ = 0.0002）。年龄和术后D-二聚体水平是胸外科手术后IDDVT的强有力预测因素。半剂量治疗性抗凝在预防IDDVT进展方面具有相同的效果与全剂量方案相比，不伴有任何额外的不良反应风险，可用于治疗胸外科手术后的IDDVT患者。
