Boccalon H, Elias A, Chalé J J, Cadene A, Dumoulin A
Service de Médecine Interne, Angiologie CHU Rangueil, Toulouse.
Bull Acad Natl Med. 1998;182(1):101-12; discussion 112-5.
The diagnosis of Deep Venous Thrombosis (DVT) by duplex ultrasound is absolutely possible out of specialized centers. Low Molecular Weight Heparins (LMWH) allow to obtain a greater efficacy and safety compared to Unfractionated Heparin (UFH). The control of LMWH is very reduced. Two studies have just been published on the topic of treatment of DVT at home. The group of patients treated at home with LMWH is not presenting more complications than the group of patients initially treated at the hospital with UFH. Nevertheless, these studies concern a very selective population of patients. Our center has been proceeding to a study for 4 years (1993-1997) in comparing the treatment at home of proximal DVT by LMWH then oral anticoagulant, to the initial treatment (10 days) in hospital by also using LMWH then oral anticoagulant. The first results show that there is no difference between both groups in terms of end-points: death, extension or recurrence of the thrombus, pulmonary embolism, bleeding. Therefore, the treatment of some type of proximal DVT is possible at home. Nevertheless, it is necessary to be very cautions as the population studied so far is a selected one. Etiologies of DVT are a constant obsessive fear. DVT or pulmonary embolism represents a real general disease which is going to progress along life. The intervention of a specialized center is always necessary. It is a work in team which must get the upper hand compared to an isolated medical action.
在专业中心之外，通过双功超声诊断深静脉血栓形成（DVT）绝对是可行的。与普通肝素（UFH）相比，低分子量肝素（LMWH）具有更高的疗效和安全性。LMWH的监测需求大幅减少。刚刚发表了两项关于在家治疗DVT的研究。在家接受LMWH治疗的患者组与最初在医院接受UFH治疗的患者组相比，并未出现更多并发症。然而，这些研究涉及的患者群体非常具有选择性。我们中心在1993年至1997年期间进行了一项为期4年的研究，比较了使用LMWH然后口服抗凝剂在家治疗近端DVT与同样使用LMWH然后口服抗凝剂在医院进行初始治疗（10天）的效果。初步结果显示，两组在终点方面没有差异：死亡、血栓扩展或复发、肺栓塞、出血。因此，某些类型的近端DVT在家治疗是可行的。然而，必须非常谨慎，因为到目前为止所研究的人群是经过挑选的。DVT的病因始终是一种持续存在的困扰。DVT或肺栓塞是一种真正的全身性疾病，会伴随一生发展。专业中心的介入始终是必要的。这是一项团队工作，必须比孤立的医疗行动更具优势。
