Kashtan J, Conti S, Blaisdell F W
Am J Surg. 1980 Dec;140(6):836-40. doi: 10.1016/0002-9610(80)90128-2.
One hundred fifty-six cases of deep venous thrombosis were reviewed. A previous episode of thrombosis, seen in 47 percent of the patients, was the most common predisposing factor. Medical illness, operation and local trauma were other important predisposing factors. Treatment consisted of continuous intravenous heparin therapy monitored by the activated coagulation time of whole blood (ACT). Thirty-three patients with an average ACT greater than 180 seconds had a more rapid recovery and had no recurrent deep venous thrombosis, embolism or failure to improve. Recurrent thrombosis, embolism or failure to improve was seen in 7 of 65 patients with an average ACT below 180 seconds. Major bleeding, defined as life-threatening bleeding or bleeding requiring transfusion, was not increased when the ACT was over 180 seconds, although minor bleeding was increased. Bleeding was also increased in women, elderly and postoperative patients. We advocate the use of higher doses of heparin to treat most patients with deep venous thrombosis because of the more rapid and complete recovery.
回顾了156例深静脉血栓形成病例。47%的患者曾有血栓形成发作，这是最常见的诱发因素。内科疾病、手术和局部创伤是其他重要的诱发因素。治疗包括通过全血活化凝血时间（ACT）监测的持续静脉肝素治疗。33例平均ACT大于180秒的患者恢复更快，且无复发性深静脉血栓形成、栓塞或病情无改善。65例平均ACT低于180秒的患者中有7例出现复发性血栓形成、栓塞或病情无改善。当ACT超过180秒时，定义为危及生命的出血或需要输血的出血的严重出血并未增加，尽管轻微出血有所增加。女性、老年人和术后患者的出血也有所增加。由于恢复更快、更完全，我们主张使用更高剂量的肝素治疗大多数深静脉血栓形成患者。
