Management and outcomes of calf deep vein thrombosis in patients with contraindication to full anticoagulation due to bleeding.

IF 1.5 4区医学 Q3 PERIPHERAL VASCULAR DISEASE International Angiology Pub Date : 2023-06-01 DOI:10.23736/S0392-9590.23.04947-7

Giovanna Elmi, Davide Allegri, Leonardo Aluigi, Pier L Antignani, Raffaele Aspide, Valeria Camaggi, Rosella DI Giulio, Andrea Domanico, Elisa R Rinaldi, Alberto Martignani, Gualtiero Palareti

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Abstract

Background: This prospective observational study was aimed at assessing early outcomes of inpatients with isolated distal deep vein thrombosis (IDDVT) and coexisting bleeding.

Methods: Patients received enoxaparin 4000 units daily or intermediate doses, and ultrasound surveillance (US). Primary outcomes were extension to the popliteal vein (PDVT) or symptomatic pulmonary embolism (PE), bleeding complications during the treatment and the composite of PDVT and bleeding complications. Secondary outcomes were recurrent IDDVTs and death.

Results: 90/95 patients completed the study period (30 days). PDVT occurred in 2/41 (4.9%) and in 3/45 (6.7%) subjects receiving enoxaparin 4000 units and intermediate doses respectively (OR 1.39; 95% CI: 0.22-11; P=0.72). PE occurred in only one of the 4 untreated subjects (25% vs. 0 patients taking enoxaparin 4000 units or intermediate doses; P=1.0). Recurrent IDDVTs occurred in 29 subjects (32.2%), more frequently during enoxaparin 4000 (19/29, 65.5%). Four patients died (4.4%). Bleeding complications occurred in 8 subjects (8.9%), all treated with intermediate doses (0 vs. 17.8%; P=1.0). Enoxaparin 4000 units significantly reduced the risk of the composite outcome compared with higher doses (4.9% vs. 24.4%; OR 6.31; 95% CI: 1.56-42.65; P=0.02). Major trauma significantly increased the risk of PDVT (OR 20.92; 95% CI: 2.82-427.51, P=0.01; logistic regression P=0.01). Patients with major trauma are also at increased bleeding risk (OR 5; 95% CI: 1.06-23.76, P=0.04; logistic regression P=0.03).

Conclusions: Enoxaparin 4000 units daily, supported by US, may be an option for selected patients.

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出血禁忌症患者小腿深静脉血栓形成的处理和结果。

背景:本前瞻性观察性研究旨在评估孤立性远端深静脉血栓形成(IDDVT)合并出血住院患者的早期预后。方法:患者每日服用依诺肝素4000单位或中等剂量，并进行超声监测(US)。主要结局为腘静脉延伸(PDVT)或症状性肺栓塞(PE)、治疗期间出血并发症及PDVT和出血并发症的复合。次要结局为复发性iddvt和死亡。结果:90/95例患者完成了研究期(30天)。接受依诺肝素4000单位和中等剂量的受试者中，分别有2/41(4.9%)和3/45(6.7%)发生PDVT (OR 1.39;95% ci: 0.22-11;P = 0.72)。在4名未治疗的受试者中，PE仅发生在1名患者中(25% vs.服用依诺肝素4000单位或中等剂量的患者;P = 1.0)。29例(32.2%)发生复发性iddvt，在依诺肝素4000期间更常见(19/29,65.5%)。死亡4例(4.4%)。8名受试者(8.9%)出现出血并发症，均采用中剂量治疗(0比17.8%;P = 1.0)。与较高剂量相比，依诺肝素4000单位显著降低了复合结局的风险(4.9% vs. 24.4%;或6.31;95% ci: 1.56-42.65;P = 0.02)。严重创伤显著增加PDVT的风险(OR 20.92;95% ci: 2.82 ~ 427.51, p =0.01;logistic回归P=0.01)。有严重创伤的患者出血风险也增加(OR 5;95% ci: 1.06-23.76, p =0.04;逻辑回归P=0.03)。结论:在美国的支持下，每日4000单位依诺肝素可能是特定患者的一种选择。

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来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).