Prandoni P, Villalta S, Bagatella P, Rossi L, Marchiori A, Piccioli A, Bernardi E, Girolami B, Simioni P, Girolami A
Institute of Medical Semeiotics, University Hospital of Padua, Italy.
Haematologica. 1997 Jul-Aug;82(4):423-8.
In contrast to the extensive documentation on the short-term outcome of patients with acute deep vein thrombosis (DVT) of the lower extremities, little is known about the long-term clinical course of this disease. To determine the clinical course of patients with a first episode of symptomatic DVTn over an 8-year follow-up period. The primary aims were to assess the long-term incidence of recurrent venous thromboembolism and that of the post-thrombotic syndrome. In addition, we determined mortality and evaluated potential risk factors for all these outcomes.
This was designed as a prospective cohort follow-up study. Consecutive symptomatic outpatients with a first episode of venography proven DVT were treated with an initial course of full-dose (low molecular weight) heparin, followed by at least three months of oral anticoagulants. After discharge, they were instructed to wear compression elastic stockings for at least two years. Follow-up assessments were scheduled at three and six months, and then every six months up to eight years. Diagnosis of recurrent venous thromboembolism was made according to standard criteria. The presence of post-thrombotic syndrome was evaluated using a standardized scale.
A total of 528 consecutive patients with a first episode of venography confirmed DVT were included in the study. The cumulative incidence of recurrent venous thromboembolism after two, five and eight years was 17.2, 24.3 and 29.7%, respectively. Malignancy and impaired coagulation inhibition increased the risk of recurrent venous thromboembolism (RR = 1.48 and 2.0, respectively). In contrast, surgery and recent trauma or fracture were associated with a diminished risk of recurrent venous thromboembolism (RR = 0.65 and 0.39, respectively). The cumulative incidence of post-thrombotic syndrome after two, five and eight years was 24.5, 29.6 and 29.8%, respectively. The development of ipsilateral recurrent DVT was strongly associated with the risk for post-thrombotic syndrome (risk ratio, 2.4). Survival after eight years was 69%. The presence of malignancy increased the risk of death remarkably (risk ratio, 7.1).
Symptomatic DVT carries a high risk for recurrent venous thromboembolism that persists for many years, especially in patients without transient risk factors for DVT. The post-thrombotic syndrome occurs in almost one-third of patients and is strongly related to recurrent ipsilateral DVT. Our findings challenge the widely adopted short course of anticoagulation in patients with symptomatic DVT.
与大量关于下肢急性深静脉血栓形成（DVT）患者短期结局的文献相比，对于该疾病的长期临床病程知之甚少。为了确定首次发作有症状的DVT患者在8年随访期内的临床病程。主要目的是评估复发性静脉血栓栓塞和血栓形成后综合征的长期发生率。此外，我们还确定了死亡率，并评估了所有这些结局的潜在危险因素。
本研究设计为前瞻性队列随访研究。连续的有症状门诊患者，首次静脉造影证实为DVT，初始接受全剂量（低分子量）肝素治疗，随后至少服用三个月的口服抗凝剂。出院后，指导他们穿戴弹力加压袜至少两年。随访评估安排在3个月和6个月时进行，然后每6个月进行一次，直至8年。复发性静脉血栓栓塞的诊断依据标准标准。使用标准化量表评估血栓形成后综合征的存在情况。
共有528例连续的首次静脉造影证实为DVT的患者纳入研究。2年、5年和8年后复发性静脉血栓栓塞的累积发生率分别为17.2%、24.3%和29.7%。恶性肿瘤和凝血抑制功能受损增加了复发性静脉血栓栓塞的风险（相对危险度分别为1.48和2.0）。相反，手术以及近期的创伤或骨折与复发性静脉血栓栓塞风险降低相关（相对危险度分别为0.65和0.39）。2年、5年和8年后血栓形成后综合征的累积发生率分别为24.5%、29.6%和29.8%。同侧复发性DVT的发生与血栓形成后综合征的风险密切相关（风险比为2.4）。8年后的生存率为69%。恶性肿瘤的存在显著增加了死亡风险（风险比为7.1）。
有症状的DVT有很高的复发性静脉血栓栓塞风险，且这种风险会持续多年，尤其是在没有DVT短暂危险因素的患者中。几乎三分之一的患者会出现血栓形成后综合征，且与同侧复发性DVT密切相关。我们的研究结果对有症状DVT患者广泛采用的短期抗凝疗程提出了挑战。
