在非癌症急性静脉血栓塞栓症患者使用Vena Cava过器后的结果:基于人口的研究
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
概括
阴静脉过器 (VCF) 仅在有活跃出血和对抗凝血药物的禁忌的患者中降低死亡风险. 在所有群体中使用静脉血栓增加了深静脉血栓的风险,质疑它们对静脉血栓栓塞的广泛益处.
科学领域:
- 血管外科
- 心脏病学
- 医疗器械
背景情况:
- 有限的证据支持静脉膜 (VCF) 的好处.
- 急性静脉血栓塞栓症 (VTE) 对健康构成重大风险.
- 抗凝血是静脉瘤的主要治疗方法,但存在禁忌.
研究的目的:
- 在非癌症患者中评估VCF的有效性和安全性.
- 确定VCF是否会降低特定患者小组的死亡率和复发性VTE.
- 对抗凝血药的患者和没有抗凝血药的患者进行比较.
主要方法:
- 来自加利福尼亚州医院的非癌症患者的回顾性分析 (2005-2010).
- 基于抗凝血禁忌的分层 (活跃出血,重大手术).
- 用于调整风险投资组与非风险投资组基线差异的倾向分数方法.
主要成果:
- 在没有抗凝血禁忌的患者中,VCFs没有降低死亡率.
- 在活跃出血的患者中,使用VCF显著降低了30日和90天的死亡率.
- 在接受重大手术的患者中,使用VCF并没有降低死亡率.
- 在所有分析小组中,使用过器并没有降低肺栓塞风险,但增加了深静脉血栓形成风险.
结论:
- 只有在急性静脉瘤患者中,静脉膜过器有助于降低短期死亡率.
- 这些发现与现有的指导方针一致,该指导方针仅对无法接受抗凝药的患者进行推.
- 深静脉血栓的风险增加需要仔细考虑VCF的使用.
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