単一の負の全足圧縮超音波による深静脈栓塞のリスク:体系的なレビューとメタ解析
Stacy A Johnson1, Scott M Stevens, Scott C Woller
1Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA.
JAMA
|February 4, 2010
まとめ
深静脈血栓症 (DVT) の全足圧縮超音波 (CUS) の陰性後に抗凝固剤を差し止めると,静脈血栓栓塞栓症のリスクが低いことが示されました. この単一の陰性検査は,DVTを確実に排除し,さらなる検査と治療を回避することができます.
科学分野:
- 血管医学 血管医学とは
- 診断用イメージング
- トロンボシス研究研究
背景:
- 圧縮超音波 (CUS) は,下肢深静脈血栓症 (DVT) の疑いに対する標準です.
- 初期CUSが陰性である患者は,しばしば再スキャンを必要とします.
- Whole-leg CUSは,近辺および遠端DVTの単一の評価を提供します.
研究 の 目的:
- 静脈血栓塞栓症 (VTE) のリスクを評価する.
- DVTの疑いのある患者の抗凝固剤の停止を評価する.
- 単一の負の全脚CUS結果後の結果を分析する.
主な方法:
- ランダム化比較試験と前向きなコホート研究の体系的レビュー.
- MEDLINE,EMBASE,CINAHL,LILACS,Cochrane,およびHTAのデータベース (1970-2009) を検索した.
- DVTの疑い,全足CUSの陰性,抗凝固薬の欠如,およびVTEイベントの90日以上のフォローアップの患者を含む.
主要な成果:
- 7つの研究では,全足CUSが陰性であった4731人の患者が含まれており,がんや最近の大手手術を受けた患者も含まれていました.
- VTEまたは疑われるVTE関連の死亡は,34人の患者 (0.7%) で発生しました.
- 3ヶ月のVTEイベント率の合計は0.57% (95%CI,0.25%-0.89%) でした.
結論:
- 単一の陰性全足CUS後に抗凝固剤を控えることは,低VTEリスクと関連しています.
- 負の全足CUSは,この患者群でDVTを効果的に排除することができます.
- このアプローチは,再検査の必要性と不必要な抗凝固剤の必要性を減らすことができます.
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