静脉支架后的抗凝管理和复发性血栓形成,用于深静脉血栓形成和血栓后综合征
Jay M Bakas1, Mandy N Lauw2, Marieke J H A Kruip2
1Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
概括
对深静脉血栓症 (DVT) 和血栓后综合征 (PTS) 进行静脉支架后的抗凝管理显示,复发性静脉血栓栓塞 (VTE) 发生率高. 没有明确的风险因素被确定,强调需要基于证据的建议.
科学领域:
- 血管外科 血管外科
- 干预性放射学 干预性放射学
- 血液学 血液学 血液学
背景情况:
- 目前的指导方针缺乏基于证据的建议,用于静脉支架后的抗凝管理.
- 深静脉血栓症 (DVT) 和血栓后综合征 (PTS) 的管理通常涉及静脉支架.
- 优化抗凝策略对于预防复发性静脉血栓塞栓症 (VTE) 至关重要.
研究的目的:
- 评估DVT和PTS患者静脉支架后的抗凝固管理策略.
- 评估干预后复发性VTE和支架血栓瘤的发生率.
- 为了确定与静脉支架后复发性VTE相关的潜在风险因素.
主要方法:
- 对79名接受DVT或PTS静脉支架治疗的患者的回顾性分析 (2006年5月 - 2021年11月).
- 主要终点:干预后的抗凝剂或抗血小板治疗管理.
- 二级终点:复发性静脉瘤,支架通透性和风险因素分析 (血栓友好症,左侧阴道静脉压缩综合征).
主要成果:
- 复发性VTE发生在38%的患者中,主要是由于支架再血栓形成 (93%).
- 72%的患者继续服用抗凝药;停止服用抗凝药并没有显著增加静脉瘤风险.
- 左下静脉压缩综合征与复发性静脉动脉突发症的减少有关,而血栓友好症在无变量分析中显示风险增加.
结论:
- 在为DVT/PTS进行静脉支架后,观察到高比例的复发性VTE,主要是支架再血栓形成.
- 目前的抗凝血管理策略似乎不足以预防复发性VTE.
- 需要进一步的研究,以建立基于证据的指导方针,用于静脉支架后的抗凝血药物.
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