急性静脈血栓塞栓症の非癌患者におけるヴァーナ・カヴァーフィルター使用後の結果:集団ベースの研究
Richard H White1, Ann Brunson2, Patrick S Romano2
1From Division of General Internal Medicine (R.H.W., P.S.R., Z.L.) and Division of Hematology Oncology (A.B., T.W.), Department of Medicine, University of California, Davis School of Medicine, Sacramento. rhwhite@ucdavis.edu.
Circulation
|April 7, 2016
まとめ
静脈穴フィルター (VCF) は,活発な出血と抗凝固薬に対する禁忌がある患者においてのみ死亡リスクを低減させた. VCFの使用は,すべてのグループで深静脈血栓症のリスクが増加し,静脈血栓栓症に対するその広範な利点に疑問を投げかけています.
科学分野:
- 血管 外科
- 心臓病科
- 医療機器
背景:
- 静脈穴フィルター (VCF) の利点を裏付ける証拠は限られている.
- 急性静脈血栓塞栓症 (VTE) は健康に重大なリスクをもたらす.
- 抗凝固薬はVTEの主な治療法ですが,禁忌があります.
研究 の 目的:
- 急性VTEの非がん患者におけるVCFの有効性と安全性の評価.
- 特定の患者のサブグループでVCFが死亡率と再発性VTEを減少させるかどうかを判断する.
- 抗凝固薬に対する禁忌がある患者とない患者のVCFのアウトカムを比較する.
主な方法:
- カリフォルニアの病院 (2005年−2010年) の急性VTEの非癌患者の遡及分析.
- 抗凝固抗症候群 (活発な出血,大手術) による分層化
- VCFとVCF以外のグループ間のベースラインの差を調整するために使用される傾向スコア方法.
主要な成果:
- VCFは,抗凝固薬の禁忌がない患者では死亡率を低下させなかった.
- VCFの使用は,活発な出血の患者の30日および90日間の死亡率を著しく低下させました.
- 大手手術を受けた患者では,VCFの使用は死亡率を低下させなかった.
- フィルターの使用は肺栓塞のリスクを低下させなかったが,分析されたすべてのサブグループで深静脈血栓のリスクを増加させた.
結論:
- 静脈内膜フィルターは,抗凝固薬に対する抗症候群が活発な静脈内膜炎患者においてのみ,短期的な死亡率を低減するのに有益である.
- 抗凝固剤を受けられない患者にのみVCFを推奨する既存のガイドラインと一致しています.
- 深静脈血栓症のリスクが高まっているため,VCFの使用は慎重に検討する必要があります.
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