Scott M P, Jezic G A, Swenson J R
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, USA.
Arch Phys Med Rehabil. 1997 May;78(5):538-9. doi: 10.1016/s0003-9993(97)90172-6.
Several studies have suggested that if a calf vein thrombosis does not propagate above the knee when followed up with serial diagnostic studies, full anticoagulation may not be necessary. These studies have not included spinal cord injured patients. Two patients with spinal cord injury were diagnosed with acute calf vein thrombosis after admission to a spinal cord injury rehabilitation unit. Both patients refused intravenous heparinization. Serial duplex Doppler studies were performed on both patients to evaluate for propagation of thrombus. Neither patient developed propagation of thrombus, pulmonary embolus, or persistent thrombophlebitis. Full anticoagulation including intravenous heparinization is costly, subject to complications, and interferes with intensive rehabilitation therapies. Observation of calf vein thrombosis with appropriate serial follow-up studies may be a viable alternative to anticoagulation in spinal cord injured patients. Further studies need to be done with this unique patient population.
多项研究表明，如果通过系列诊断研究随访发现小腿静脉血栓未蔓延至膝盖以上，则可能无需进行充分抗凝治疗。这些研究未纳入脊髓损伤患者。两名脊髓损伤患者在入住脊髓损伤康复单元后被诊断为急性小腿静脉血栓形成。两名患者均拒绝静脉注射肝素。对两名患者均进行了系列双功多普勒研究以评估血栓是否蔓延。两名患者均未出现血栓蔓延、肺栓塞或持续性血栓性静脉炎。包括静脉注射肝素在内的充分抗凝治疗成本高昂、有并发症风险且会干扰强化康复治疗。对脊髓损伤患者的小腿静脉血栓进行适当的系列随访观察可能是抗凝治疗的一种可行替代方案。需要对这一特殊患者群体开展进一步研究。
