Grau Segura E, Real Vila E, Pastor Guzmán E, Torró Richart J A, Garay Burdeos M
Servicio de Hematología-Hemoterapia, Hospital Lluís Alcanyís de Xátiva, Valencia.
Rev Clin Esp. 1997 Jun;197(6):398-401.
Low-molecular-weight heparins (LMWH) have shown to be at least as safe and efficient as non-fractionated heparin in the treatment of deep-vein thrombosis (DVT). Moreover, no serial laboratory controls are required. Therefore, LMWH allow the patients to be treated at home. From July 1995 to July 1996, 30 consecutive patients with DVT were enrolled in a prospective study and treated with nadroparin. Ambulatory treatment was feasible in 24 patients (9 patients did not require admission and 15 patients were discharged in less than 6 days). The main causes for admission were the inability to obtain a diagnosis, the severity of symptoms in the involved limb, and the presence of associated disease. None of the 24 patients to whom the possibility of home therapy was offered desired to remain at hospital. The ambulatory care of these patients increased the burden on primary care teams. There was no case of clinical recurrent thromboembolism nor a major hemorrhagic complication. Ambulatory treatment of DVT with nadroparin seems to be feasible, efficient and safe. Nevertheless, before using this therapeutic alternative a series of factors should be considered, which include the severity of clinical presentation, the embolic and hemorrhagic risks, and the presence of associated diseases.
低分子量肝素（LMWH）在治疗深静脉血栓形成（DVT）方面已被证明至少与普通肝素一样安全有效。此外，无需进行系列实验室检查。因此，LMWH可让患者在家中接受治疗。1995年7月至1996年7月，30例连续性DVT患者被纳入一项前瞻性研究并接受那屈肝素治疗。24例患者可行门诊治疗（9例患者无需住院，15例患者在6天内出院）。住院的主要原因是无法确诊、受累肢体症状严重以及存在相关疾病。在被提供家庭治疗可能性的24例患者中，无人希望留在医院。这些患者的门诊护理增加了基层医疗团队的负担。未发生临床复发性血栓栓塞事件，也未出现严重出血并发症。用那屈肝素对DVT进行门诊治疗似乎可行、有效且安全。然而，在采用这种治疗选择之前，应考虑一系列因素，包括临床表现的严重程度、栓塞和出血风险以及相关疾病的存在情况。
