静脈内血栓の除去は,急性筋深静脈血栓症のために行われます
Anthony J Comerota1, Clive Kearon2,3, Chu-Shu Gu4,3
1Inova Heart and Vascular Institute, Inova Alexandria Hospital, VA (A.J.C.).
Circulation
|December 28, 2018
まとめ
薬用メカニカルカテーテル誘導性血栓解離 (PCDT) は,骨頭側深静脈血栓症の患者でPTSを予防しなかった. しかし,PCDTはPTSの重症度を低下させ,生活の質を向上させました.
科学分野:
- 血管医学
- 介入心臓科
- トロンボシス 研究
背景:
- 以前,ATTRACT試験では,急性近道深静脈血栓症 (DVT) の後血栓症候群 (PTS) の予防に,薬理学的なカテーテル誘導性血栓溶解 (PCDT) が無効であることが示されました.
- この分析では,ATTRACT試験のコホート内で,PCDTが iliofemoral DVT患者に与える影響を具体的に調査しています.
研究 の 目的:
- 急性DVT患者におけるPTSの発生率と重症度の低下におけるPCDTの有効性を評価する.
- 足の症状,生活の質,再発性静脈血栓塞栓症に対するPCDTの長期的な影響を評価する.
主な方法:
- 391人の急性DVT患者の多センターランダム化試験.
- 患者はPCDTと抗凝固薬または抗凝固薬のみ (PCDTなし) にランダムに分けられました.
- PTS発生,重症度スコア,症状の軽減,生活の質,出血事件を含む24ヶ月のフォローアップ期間でアウトカムが評価されました.
主要な成果:
- PCDT群とPCDT群の間のPTS発生の有意な差異は24ヶ月で (49%対51%) ありませんでした.
- PCDTはPTSの重度スコア (Villaltaと静脈性臨床重度スコア) と中等から重度のPTS患者の割合を有意に低下させた.
- PCDTは短期間で足の痛みや腫れを軽減し,静脈疾患特有の生活の質を改善しましたが,一般的な生活の質には影響しませんでした.
- 重度の出血および再発性静脈血栓塞栓症の割合は,グループによって類似していました.
結論:
- PCDTは急性DVTにおけるPTSの発生を防ぐことはできませんが,その重症性を著しく軽減します.
- PCDTは,足の初期症状を改善し, iliofemoral DVTの患者の長期的な生活の質を改善します.
- これらの発見は,PTSの発症を予防しないにもかかわらず,長期の続発を緩和するために,PCDTが iliofemoral DVTの管理に役割を果たすことを示唆しています.
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