凝血监测,剂量调整的导管导向血栓溶解或在深静脉血栓症中药理机械血栓去除
Julian Kleine Wortmann1,2, Stefano Barco2, Riccardo M Fumagalli2
1Medical Faculty, University of Zurich, Switzerland.
VASA. Zeitschrift fur Gefasskrankheiten
|October 17, 2023
概括
药物机械血栓切除术 (PMT) 和导管导向血栓溶解 (CDT) 是安全有效的治疗 iliofemoral 深静脉血栓 (DVT) 的方法. 与CDT相比,单次PMT显示出有希望的结果,具有较高的通透率和较少的出血并发症.
科学领域:
- 血管外科 血管外科
- 干预性放射学 干预性放射学
- 血栓形成的管理
背景情况:
- 急性深静脉血栓症 (DVT) 可以导致血栓后综合征 (PTS).
- 药物机械血栓切除术 (PMT) 和导管导向血栓溶解 (CDT) 是 iliofemoral DVT 的选择.
- 预防PTS和保持静脉通透是治疗的关键目标.
研究的目的:
- 为了比较单独使用PMT,单独使用CDT和结合使用CDT-PMT的临床特征和结果,用于 iliofemoral DVT.
- 为了评估外干预性出血并发症.
- 评估长期PTS发病率和支架通透度.
主要方法:
- 来自瑞士静脉支架注册局的159名患有症状的 iliofemoral DVT 的患者的回顾性分析.
- 患者接受了单独的PMT,单独的CDT或CDT与救助PMT.
- 主要结局: ISTH 大/小出血. 二次结局:PTS,3年后的支架穿透性.
主要成果:
- 对于特定患者的个人资料 (例如,下腹静脉压缩) 首选单次PMT.
- 单独使用PMT,使用的r-tPA剂量低于CDT.
- 主要出血率:0% (PMT),1% (CDT),2% (CDT-PMT). 这种情况的发生率很高. 轻微出血率:0% (PMT),1% (CDT),12% (CDT-PMT) 较小的出血率:0% (PMT),1% (CDT),12% (CDT-PMT) 较小的出血率:0% (PMT),1% (CDT),12% (CDT-PMT) 较小的出血率:0% (PMT),1% (CDT),12% (CDT-PMT) 较小的出血率:1% (CDT-PMT).
- 3年的PTS率:6% (PMT),9% (CDT),7% (CDT-PMT). 这三年间的PTS率为6% (PMT),9% (CDT),7% (CDT-PMT). 3年初级支架穿透率:95% (PMT),88% (CDT),83% (CDT-PMT) 在3年内.
结论:
- PMT和CDT是安全和有效的 iliofemoral DVT,产生高的长期通透性.
- 单场PMT显示出数量上优异的初级通透性和较低的出血率比CDT.
- 这两种方法都有助于成功治疗和预防PTS.
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