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上肢深静脉血栓形成的风险与预后

Risk and Prognosis of Upper Extremity Deep Vein Thrombosis.

作者信息

Endo Yusuke, Unno Naoki, Yamamoto Naoto, Sano Masaki, Katahashi Kazuto, Kayama Takafumi, Yamanaka Yuta, Tsuyuki Hajime, Takeuchi Hiroya, Inuzuka Kazunori

机构信息

Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.

Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.

出版信息

Ann Vasc Dis. 2023 Sep 25;16(3):200-204. doi: 10.3400/avd.oa.23-00005.

Abstract

We aimed to investigate the clinical features of upper extremity deep vein thrombosis (UEDVT). We retrospectively reviewed the background, thrombus site, treatment, and outcome of 76 UEDVT patients. Of the 76 UEDVT patients, 44 (57.9%) were men, and 51 (67.1%) were complicated by malignancy, 44 (57.9%) had an indwelling central vein (CV) catheter, 8 (10.5%) had concomitant pulmonary embolization (PE), and 33 (43.3%) were symptomatic. Regarding the thrombus site, the right internal jugular vein was the most common, with 30 cases (35.3%). As regards the treatment method, 53 patients (69.7%) received oral anticoagulants. In 2015, when direct oral anticoagulants (DOACs) was covered by insurance, there were 44 UEDVT cases, of which 34 (77.3%) received DOACs. Outcomes at a mean observation period of 37.5±41.5 months included 40 deaths (52.6%) with a mean survival of 16.3±21.3 months. The most common cause of death was malignancy, with 33 cases (82.5%). In the background of UEDVT, the combination of indwelling CV catheter placement and malignancy was frequently observed. While the risk of recurrence or PE complications is low, the prognosis of UEDVT complicated by malignancy is extremely poor.

摘要

我们旨在调查上肢深静脉血栓形成(UEDVT)的临床特征。我们回顾性分析了76例UEDVT患者的背景、血栓部位、治疗及预后情况。76例UEDVT患者中,男性44例(57.9%),51例(67.1%)合并恶性肿瘤,44例(57.9%)有中心静脉(CV)留置导管,8例(10.5%)合并肺栓塞(PE),33例(43.3%)有症状。血栓部位方面,右侧颈内静脉最为常见,共30例(35.3%)。治疗方法上,53例患者(69.7%)接受口服抗凝药治疗。2015年,直接口服抗凝剂(DOACs)纳入医保后,有44例UEDVT病例,其中34例(77.3%)接受DOACs治疗。平均观察期37.5±41.5个月的预后情况包括40例死亡(52.6%),平均生存期16.3±21.3个月。最常见的死亡原因是恶性肿瘤,共33例(82.5%)。在UEDVT背景下,常观察到CV留置导管置入与恶性肿瘤并存的情况。虽然复发或PE并发症风险较低,但合并恶性肿瘤的UEDVT预后极差。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a0bf/10539128/60202f24c2de/avd-16-3-oa.23-00005-figure01.jpg

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