Umetsu Michihisa, Yamaki Takashi, Ogawa Tomohiro, Nishibe Toshiya, Shiraishi Yasushi, Yamada Norikazu, Matsumoto Takashi, Nomura Tadashi, Tabuchi Atsushi, Yamashita Yugo, Nemoto Hiroko, Hiromatsu Shinichi, Mo Makoto
Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan.
Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan.
Ann Vasc Dis. 2025;18(1). doi: 10.3400/avd.oa.25-00061. Epub 2025 Aug 14.
The introduction of direct oral anticoagulants (DOACs) has significantly changed the management of deep vein thrombosis (DVT) in Japan. This study aimed to elucidate recent trend0s in the diagnosis and management of DVT following this shift. This retrospective observational study involved 154 patients with acute and subacute DVT, and 96 patients with chronic or unknown-onset DVT, diagnosed between October 1 and 31, 2020, across 29 institutions affiliated with the Japanese Society of Phlebology. Data included patient demographics, diagnostic modalities, thrombus location, treatments, and clinical outcomes. The mean age was 70.0 years, and 57.8% of patients were female. Duplex ultrasonography was the predominant diagnostic modality (96.1%). DOACs were prescribed in 64.9% of patients, replacing warfarin and heparin. Compression therapy was used in 41.6% of patients. Soleal vein thrombosis was significantly more common in isolated distal DVT (right: 50.6% vs. 30.0%, p = 0.0082; left: 66.3% vs. 35.2%, p = 0.0001). Major bleeding occurred in 3.2% of patients. Post-thrombotic syndrome was observed in 0.6% of patients with acute/subacute DVT and 12.0% of those with chronic DVT patients. Since the introduction of DOACs, DVT management in Japan has evolved considerably. Periodic multicenter surveys would be beneficial for evaluating long-term outcomes, treatment safety, and evolving clinical practices.
直接口服抗凝剂（DOACs）的引入显著改变了日本深静脉血栓形成（DVT）的管理方式。本研究旨在阐明这一转变后DVT诊断和管理的近期趋势。这项回顾性观察研究纳入了2020年10月1日至31日期间在日本静脉病学会下属的29家机构诊断的154例急性和亚急性DVT患者以及96例慢性或发病情况不明的DVT患者。数据包括患者人口统计学信息、诊断方式、血栓位置、治疗方法和临床结局。患者平均年龄为70.0岁，57.8%为女性。双功超声检查是主要的诊断方式（96.1%）。64.9%的患者使用了DOACs，取代了华法林和肝素。41.6%的患者采用了压迫治疗。孤立性远端DVT中，比目鱼肌静脉血栓形成明显更为常见（右侧：50.6%对30.0%，p = 0.0082；左侧：66.3%对35.2%，p = 0.0001）。3.2%的患者发生了大出血。急性/亚急性DVT患者中有0.6%出现了血栓后综合征，慢性DVT患者中有12.0%出现了该综合征。自引入DOACs以来，日本的DVT管理有了很大发展。定期进行多中心调查将有助于评估长期结局、治疗安全性和不断变化的临床实践。
