Bory M, Yvorra S, Desfossez L, Panagides D, Bonnet J L, Massiani P F
Service de Cardiologie A, CHU Timone, Marseille.
Presse Med. 1994 May 14;23(18):839-44.
Venous stasis in bedridden patients is recognized as one of the risk factors for venous thromboembolism but the phenomena is known to occur in ambulatory subjects and another cause must be involved. We investigated a series of consecutive ambulatory patients with venous thromboembolism in order to distinguish the particular clinical manifestations and possible aetiologies.
We compared a retrospective series of 120 consecutive patients with deep vein thromboembolism of the lower limbs and 127 patients with the same disease who had been bedridden at onset. In addition to the physical examination, the aetiological work-up included echography (n = 14), abdominal computed tomography (n = 38) and/or haemostasis studies (n = 61). Mean follow up was 23 +/- 13 months (range 1-45 months).
Family history of deep venous thromboembolism was found in 17 patients and recurrence was observed in 50 patients. Phlebitis was on the right in 52 cases, on the left in 47 and bilateral in 17. Proximal locations were more frequent (74%) and pulmonary embolism occurred in one-half of the patients (n = 58). A cause was identified in 61 cases (50.8%): cancer (n = 24, 17 known, 7 previously unknown), dyscrasia (n = 17, protein S or C deficiency (5), increased plasminogen activator inhibitor I (8), circulating anticoagulants (3), hypofibrinogen (1), idiopathic varicose veins (n = 7), pregnancy (n = 5), oral contraceptives (n = 4) and other causes (n = 4). No cause was identified in 59 patients. Pulmonary embolism led to death in 4 cases. Seven patients were lost to follow-up and anticoagulation therapy was taken by 79 (72%) then interrupted in the others 3 to 6 months later. Eighteen patients died, 14 due to the underlying disease, 2 from new cancers and 12 after recurrent thromboembolism.
Ambulatory venous embolism is as frequent as embolism in bedridden patients and the cause can be observed in 50% of the cases.
卧床患者的静脉淤滞被认为是静脉血栓栓塞的危险因素之一，但已知这种现象也会发生在非卧床患者中，必然涉及其他原因。我们对一系列连续的非卧床静脉血栓栓塞患者进行了调查，以区分其特殊的临床表现和可能的病因。
我们比较了回顾性研究中的120例连续的下肢深静脉血栓栓塞患者和127例起病时即卧床的相同疾病患者。除体格检查外，病因检查包括超声检查（n = 14）、腹部计算机断层扫描（n = 38）和/或止血研究（n = 61）。平均随访时间为23±13个月（范围1 - 45个月）。
17例患者有深静脉血栓栓塞家族史，50例患者出现复发。静脉炎发生在右侧52例，左侧47例，双侧17例。近端部位更为常见（74%），一半患者（n = 58）发生肺栓塞。61例（50.8%）患者找到了病因：癌症（n = 24，17例已知，7例先前未知）、血液系统疾病（n = 17，蛋白S或C缺乏（5例）、纤溶酶原激活物抑制剂I增加（8例）、循环抗凝物质（3例）、纤维蛋白原减少（1例））、特发性静脉曲张（n = 7）、妊娠（n = 5）、口服避孕药（n = 4）及其他原因（n = 4）。59例患者未找到病因。4例患者因肺栓塞死亡。7例患者失访，79例（72%）接受了抗凝治疗，其他患者在3至6个月后中断治疗。18例患者死亡，14例死于基础疾病，2例死于新发癌症，12例死于复发性血栓栓塞。
非卧床患者的静脉栓塞与卧床患者的栓塞发生率相同，50%的病例可找到病因。
