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JAMA Surg:抗凝治疗小腿孤立性DVT利弊分析

2016-08-09 Seven L 译 MedSci原创

目的:评估诊断小腿孤立性深静脉血栓(DVT)后,抗凝治疗能否降低近端DVT或肺栓塞(PE)风险。方法:纳入384名小腿孤立性DVT患者,排除标准:抗凝治疗禁忌、180天内前次抗凝治疗、可疑或诊断PE等。以诊断DVT后180天内近端DVT或PE发生率为主要结局指标。结果:384例进行分析的患者中222名男性[57.8%]; 162名女性[42.2%];平均[SD]年龄60 [16]岁。243例(63

目的:评估诊断小腿孤立性深静脉血栓(DVT)后,抗凝治疗能否降低近端DVT或肺栓塞(PE)风险。

方法:纳入384名小腿孤立性DVT患者,排除标准:已经接受抗凝治疗,或存在抗凝治疗的禁忌症,或在过去180天内有VTE,或在首次发现DVT时即诊断PE。以诊断DVT后180天内近端DVT或PE发生率为主要结局指标。

结果:384例进行分析的患者中222名男性[57.8%]; 162名女性[42.2%];平均[SD]年龄60 [16]岁。243例(63.2%)例位于轴向静脉(胫前、胫后、腓)小腿DVT涉及,215(56%)例位于肌支(比目鱼肌和腓肠肌肌支)。医生试图对243例(63.3%)进行抗凝治疗管理,余下141例作为对照组。

干预组和对照组近端DVT分别发生4(1.6%)例和7(5.0%)例;PE分别发生4(1.6%)例和6(4.3%)例。抗凝治疗可降低180天近端DVT或PE风险(OR=0.34; 95% CI, 0.14-0.83),但是会增加出血风险(OR=4.35; 95% CI, 1.27-14.9);校正混杂因素后,关系仍存在(分别为:ORs, 0.33 [95% CI, 0.12-0.87]和4.87 [95% CI, 1.37-17.3])。

结论:对于小腿孤立性DVT患者,抗凝治疗虽然可以降低近端DVT或PE风险,但增加了出血风险。

原始出处:

Utter GH.et al.Therapeutic Anticoagulation for Isolated Calf Deep Vein Thrombosis.JAMA Surg. 2016 Jul 20:e161770. doi: 10.1001/jamasurg.2016.1770. [Epub ahead of print]


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  1. 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channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-09-03 lujian
  2. 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likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sat Aug 20 07:46:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100975, encodeId=641e1009e50a, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:52:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=99101, encodeId=f2399910109, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, 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    2017-04-22 amy0558
  3. 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channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-09-05 李东泽

    很好,不错,以后会多学习

    0

  4. 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objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-09-03 doctorJiangchao

    继续学习

    0

  5. 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channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-09-03 doctorJiangchao

    继续关注

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-08-20 jyzxjiangqin

    要注意并发症及不良反应。

    0

  7. 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objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-08-19 136****0753赵

    值得学习

    0

  8. 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likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sat Aug 20 07:46:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100975, encodeId=641e1009e50a, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:52:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=99101, encodeId=f2399910109, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-08-16 lalalallalalaalla

    继续学习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1744803, encodeId=d7e11e4480312, content=<a href='/topic/show?id=d8c6322986a' target=_blank style='color:#2F92EE;'>#利弊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32298, encryptionId=d8c6322986a, topicName=利弊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a8135449354, createdName=lujian, createdTime=Sat Sep 03 06:15:00 CST 2016, time=2016-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1649621, encodeId=bac2164962109, content=<a href='/topic/show?id=49f9634e90' target=_blank style='color:#2F92EE;'>#DVT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6347, encryptionId=49f9634e90, topicName=DVT)], attachment=null, authenticateStatus=null, createdAvatar=null, 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likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sat Aug 20 07:46:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100975, encodeId=641e1009e50a, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:52:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=99101, encodeId=f2399910109, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-08-12 doctorJiangchao

    继续关注

    0

  10. 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likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sat Aug 20 07:46:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=100975, encodeId=641e1009e50a, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:52:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=99101, encodeId=f2399910109, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97825, encodeId=48779e8250d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97826, encodeId=a4539e826c9, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:51:00 CST 2016, time=2016-08-12, status=1, ipAttribution=)]
    2016-08-12 doctorJiangchao

    继续学习

    0

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