AbuRahma A F, Stickler D L, Robinson P A
Department of Surgery and the Vascular Laboratory, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, USA.
J Vasc Surg. 1998 Oct;28(4):630-7. doi: 10.1016/s0741-5214(98)70087-4.
The long-term risk for recurrent deep venous thrombosis (DVT) and the incidence of post-thrombotic syndrome (PTS) after long-term anticoagulation (LTA) therapy have been widely debated. In this study, we compare the results of short-term anticoagulation therapy versus conventional LTA therapy in patients with DVT of the lower extremity.
Baseline assessments of DVT symptoms and risk factors were recorded in 105 patients. Diagnosis was made using duplex ultrasound/venography. Patients were sequentially assigned to 1 of the following treatment protocols: (A) conventional LTA therapy, which included initial intravenous standard heparin followed by warfarin on days 3 to 5 and was continued for 3 months for patients without pulmonary embolism (PE); or (B) short-term therapy, which included the same heparin therapy followed by warfarin on days 2 to 3 and was continued for 6 weeks only. Clinical and duplex ultrasound follow-up was done at 6 weeks, 3 and 6 months, and every 6 months thereafter.
Risk factors, location of DVT, and mean age of the 2 groups were comparable. Mean follow-up was 59 months. There were 4 immediate major complications in patients of group A (4 of 54 [7%]; 2 PEs and 2 significant bleeds) and 3 in patients of group B (3 of 51 [6%]; 1 PE and 2 bleeds). On long-term follow-up, 18 of 43 (42%) patients in group A and 20 of 44 (46%) patients in group B had PTS. Similarly, 10 of 43 (23%) patients in group A and 9 of 44 (20%) patients in group B had 1 or more recurrent thromboembolic events (not statistically significant). A significant difference was demonstrated only in patients with cancer; LTA was favored in reducing recurrent DVT and PTS. Two other patients in group A had late significant complications secondary to warfarin (hemorrhage in 1 and coumadin necrosis in the other), with no complications in group B. The mean number of days of hospitalization were fewer for patients in group B (5 versus 8 days), which is mainly due to earlier initiation of warfarin therapy for group B.
In this study of our local population, we observed that short-term anticoagulation therapy was as effective as LTA therapy and less costly for use in most patients. It may also carry less risk of long-term warfarin complications, such as bleeding or skin necrosis.
长期抗凝（LTA）治疗后复发性深静脉血栓形成（DVT）的长期风险以及血栓形成后综合征（PTS）的发生率一直存在广泛争议。在本研究中，我们比较了下肢DVT患者短期抗凝治疗与传统LTA治疗的结果。
记录了105例患者DVT症状和危险因素的基线评估情况。通过双功超声/静脉造影进行诊断。患者被依次分配到以下治疗方案之一：（A）传统LTA治疗，包括初始静脉注射标准肝素，然后在第3至5天开始使用华法林，对于无肺栓塞（PE）的患者持续使用3个月；或（B）短期治疗，包括相同的肝素治疗，然后在第2至3天开始使用华法林，仅持续6周。在6周、3个月和6个月以及此后每6个月进行临床和双功超声随访。
两组的危险因素、DVT部位和平均年龄具有可比性。平均随访时间为59个月。A组患者中有4例立即出现严重并发症（54例中的4例[7%]；2例PE和2例严重出血），B组患者中有3例（51例中的3例[6%]；1例PE和2例出血）。在长期随访中，A组43例患者中有18例（42%）发生PTS，B组44例患者中有20例（46%）发生PTS。同样，A组43例患者中有10例（23%）发生1次或更多次复发性血栓栓塞事件，B组44例患者中有9例（20%）发生（无统计学意义）。仅在癌症患者中显示出显著差异；LTA在减少复发性DVT和PTS方面更具优势。A组另外2例患者发生了华法林继发的晚期严重并发症（1例出血，另1例为香豆素坏死），B组无并发症。B组患者的平均住院天数较少（5天对8天），这主要是因为B组华法林治疗开始得更早。
在对我们当地人群的这项研究中，我们观察到短期抗凝治疗与LTA治疗一样有效，并且在大多数患者中使用成本更低。它还可能降低长期华法林并发症（如出血或皮肤坏死）的风险。
