Greenfield L J, Proctor M C, Rodriguez J L, Luchette F A, Cipolle M D, Cho J
Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA.
J Trauma. 1997 Jan;42(1):100-3. doi: 10.1097/00005373-199701000-00017.
The need to study methods of thromboembolism prophylaxis in high-risk trauma patients is well established. The purpose of this study was to evaluate the feasibility of a proposed study design, including current methods of prophylaxis, performance of a risk assessment profile scale, and the use of serial color-flow duplex studies in detecting deep venous thrombosis (DVT).
Patients were enrolled into the study, stratified as to their ability to receive anticoagulation and randomized to low-dose unfractionated heparin, low molecular weight heparin, pneumatic compression devices, or foot pumps with or without vena caval filters. Serial ultrasound scans were performed at designated intervals for 4 weeks. Pulmonary angiograms were obtained for clinical signs or symptoms of pulmonary embolism.
Fifty-three patients, 32 male and 21 female patients with a mean age of 44 years, completed the study. The incidence of DVT was 43% (23 of 53 patients) and significantly higher in older patients. There were no pulmonary embolisms. Color-flow duplex proved to be a sensitive method for detecting both proximal and distal thrombi. The risk assessment profile for thromboembolism (RAPT) scale identified a group of patients with a high incidence of DVT. However, the occurrence of DVT was not correlated with the magnitude of the RAPT score.
The ability to identify a population with a high incidence of thromboembolism by using the RAPT score to detect asymptomatic DVT, and the suggested advantage of low molecular weight heparin, all support the need for an appropriately powered randomized clinical trial.
研究高危创伤患者血栓栓塞预防方法的必要性已得到充分证实。本研究的目的是评估一种拟议研究设计的可行性，包括当前的预防方法、风险评估量表的性能，以及使用连续彩色多普勒超声研究检测深静脉血栓形成（DVT）。
患者被纳入研究，根据其接受抗凝治疗的能力进行分层，并随机分为接受低剂量普通肝素、低分子量肝素、气动压迫装置或带或不带腔静脉滤器的足部泵治疗。在指定的间隔时间内进行连续4周的超声扫描。对于出现肺栓塞临床体征或症状的患者进行肺血管造影。
53例患者完成了研究，其中男性32例，女性21例，平均年龄44岁。DVT的发生率为43%（53例患者中的23例），在老年患者中显著更高。未发生肺栓塞。彩色多普勒超声被证明是检测近端和远端血栓的敏感方法。血栓栓塞风险评估量表（RAPT）识别出一组DVT发生率高的患者。然而，DVT的发生与RAPT评分的大小无关。
通过使用RAPT评分检测无症状DVT来识别血栓栓塞发生率高的人群的能力，以及低分子量肝素的潜在优势，均支持进行一项有足够样本量的随机临床试验的必要性。
