Diagnosis and treatment analysis of acute deep venous thrombosis at lower extremity of 98 aged patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Guangjun , YU Zhenfeng , ZHOU Wenhua , YAO Kai , LI Chenglei , SHAN Yuanzhou , ZHANG Xueli

Department of General Surgery, Central Hospital of Fengxian District, The South Branch of The Sixth People’s Hospital of Shanghai Jiaotong University, Shanghai 201499, P.R.China;

Corresponding author：

ZHANG Guangjun, Email: zhgj73@126.com

Keywords：

acute deep venous thrombosis at lower extremity; aged patients; diagnosis; treatment

DOI：

10.7507/1007-9424.201609002

Video：

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Objective To summarize the clinical features, diagnosis, and treatment of acute deep venous thrombosis (DVT) at lower extremity of aged patients. Method Clinical data of 98 aged patients with acute DVT at lower extremity who got treatment in our hospital from Junuary 2012 to December 2014 were analyzed retrospectively. Results Of 98 aged patients with acute DVT at lower extremity, the time from disease developed to treatment was 1 day to 10 days with an average of 4 days. The main symptom was low limb swelling progressively. All the patients were treated by the comprehensive treatment based on individual anticoagulation. A total of 96 patients (98.0%) were followed up, and the follow-up period ranged from 12 months to 24 months (average of 18 months). Of 96 patients followed-up, we found a statistically significant difference between lower extremities before treatment and those at 3 months after treatment in venous clinical severity score (VCSS) and the change of lower extremity circumference (P<0.001). Of 96 patients, 9 patients were cured, 81 patients had markedly effective results, and 6 patients had effective results. None of the patients suffered from fatal pulmonary embolismin in duration of hospital day and follow-up period, and no one suffered form DVT recurrence. Conclusions The aged patients with acute DVT at lower extremity usually see a doctor lately. The comprehensive treatment based on individual anticoagulation is safe and effective in treatment of acute DVT at lower extremity of aged patients.

Citation： ZHANG Guangjun, YU Zhenfeng, ZHOU Wenhua, YAO Kai, LI Chenglei, SHAN Yuanzhou, ZHANG Xueli. Diagnosis and treatment analysis of acute deep venous thrombosis at lower extremity of 98 aged patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 732-735. doi: 10.7507/1007-9424.201609002 Copy

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2.	Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
3.	Burgazli KM, Atmaca N, MericIiler M, et al. Deep vein thrombosis and novel oral anticoagulants: a clinical review. Eur Rev Med Pharmacol Sci, 2013, 17(23): 3123-3131.
4.	White RH. The epidemiology of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I4-I8.
5.	Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
6.	张昌列, 宋志红. 瑞替普酶治疗下肢深静脉血栓形成的临床观察. 重庆医学, 2015, 44(2): 207-208, 211.
7.	Stein PD, Matta F. Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism. Crit Care Clin, 2011, 27(4): 907-932.
8.	Ho WK, Hankey GJ, Eikelboom JW. The incidence of venous thromboembolism: a prospective, community-based study in Perth, Western Australia. Med J Aust, 2008, 189(3): 144-147.
9.	刘杰, 费蕾, 周乐红, 等. 下肢深静脉血栓形成后并发肺栓塞相关危险因素分析. 临床外科杂志, 2013, 21(3): 169-171.
10.	Esmon CT. Basic mechanisms and pathogenesis of venous thrombosis. Blood Rev, 2009, 23(5): 225-229.
11.	Timp JF, Braekkan SK, Versteeg HH, et al. Epidemiology of cancer-associated venous thrombosis. Blood, 2013, 122(10): 1712-1723.
12.	王雪钢, 蒋岚杉, 白斗, 等. 急性下肢深静脉血栓患者危险因素分析. 中国普外基础与临床杂志, 2014, 21(10): 1264-1267.
13.	Friera-Reyes A, Caballero P, Ruiz-Giménez N, et al. Usefulness of fast ELISA determination of D-dimer levels for diagnosing pulmonary embolism in an emergency room. Arch Bronconeumol, 2005, 41(9): 499-504.
14.	Jennersjö CM, Fagerberg IH, Karlander SG, et al. Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis. Blood Coagul Fibrinolysis, 2005, 16(7): 517-523.
15.	李晓曦. 静脉血栓栓塞性疾病的诊断、治疗和 D-二聚体的检验. 中国血管外科杂志(电子版), 2013, 5(1): 11-13.
16.	Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e419S-e494S.
17.	汪忠镐, 李震. 深静脉血栓治疗的商榷. 中国普外基础与临床杂志, 2012, 19(11): 1149-1151.
18.	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第二版). 中国血管外科杂志(电子版), 2013, 5(1): 23-26.
19.	Wibur J, Shian B. Deep venous thrombosis and pulmonary embolism: current therapy. Am Fam Physician, 2017, 95(5): 295-302.
20.	Jacobson BF, Louw S, Büller H, et al. Venous thromboembolism: prophylactic and therapeutic practice guideline. S Afr Med J, 2013, 103(4 Pt 2): 261-267.
21.	Gonzalez-Fajardo JA, Arreba E, Castrodeza J, et al. Venographic comparison of subcutaneous low-molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis. J Vasc Surg, 1999, 30(2): 283-292.
22.	Büller HR, Gent M, Gallus AS, et al. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators. N Engl J Med, 1997, 337(10): 657-662.
23.	李文东, 李晓强, 钱爱民, 等. 下肢深静脉血栓形成治疗进展. 中国实用外科杂志, 2014, 34(12): 1190-1193.
24.	Ma C, Zhang Y, Xu Q, et al. Influence of warfarin dose-associated genotypes on the risk of hemorrhagic complications in Chinese patients on warfarin. In J Hematol, 2012, 96(6): 719-728.
25.	Ridker PM, Goldhaber SZ, Danielson E, et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med, 2003, 348(10): 1425-1434.

1. Nitta D, Mitani H, Ishimura R, et al. Deep vein thrombosis risk stratification. Int Heart J, 2013, 54(3): 166-170.
2. Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
3. Burgazli KM, Atmaca N, MericIiler M, et al. Deep vein thrombosis and novel oral anticoagulants: a clinical review. Eur Rev Med Pharmacol Sci, 2013, 17(23): 3123-3131.
4. White RH. The epidemiology of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I4-I8.
5. Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
6. 张昌列, 宋志红. 瑞替普酶治疗下肢深静脉血栓形成的临床观察. 重庆医学, 2015, 44(2): 207-208, 211.
7. Stein PD, Matta F. Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism. Crit Care Clin, 2011, 27(4): 907-932.
8. Ho WK, Hankey GJ, Eikelboom JW. The incidence of venous thromboembolism: a prospective, community-based study in Perth, Western Australia. Med J Aust, 2008, 189(3): 144-147.
9. 刘杰, 费蕾, 周乐红, 等. 下肢深静脉血栓形成后并发肺栓塞相关危险因素分析. 临床外科杂志, 2013, 21(3): 169-171.
10. Esmon CT. Basic mechanisms and pathogenesis of venous thrombosis. Blood Rev, 2009, 23(5): 225-229.
11. Timp JF, Braekkan SK, Versteeg HH, et al. Epidemiology of cancer-associated venous thrombosis. Blood, 2013, 122(10): 1712-1723.
12. 王雪钢, 蒋岚杉, 白斗, 等. 急性下肢深静脉血栓患者危险因素分析. 中国普外基础与临床杂志, 2014, 21(10): 1264-1267.
13. Friera-Reyes A, Caballero P, Ruiz-Giménez N, et al. Usefulness of fast ELISA determination of D-dimer levels for diagnosing pulmonary embolism in an emergency room. Arch Bronconeumol, 2005, 41(9): 499-504.
14. Jennersjö CM, Fagerberg IH, Karlander SG, et al. Normal D-dimer concentration is a common finding in symptomatic outpatients with distal deep vein thrombosis. Blood Coagul Fibrinolysis, 2005, 16(7): 517-523.
15. 李晓曦. 静脉血栓栓塞性疾病的诊断、治疗和 D-二聚体的检验. 中国血管外科杂志(电子版), 2013, 5(1): 11-13.
16. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e419S-e494S.
17. 汪忠镐, 李震. 深静脉血栓治疗的商榷. 中国普外基础与临床杂志, 2012, 19(11): 1149-1151.
18. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第二版). 中国血管外科杂志(电子版), 2013, 5(1): 23-26.
19. Wibur J, Shian B. Deep venous thrombosis and pulmonary embolism: current therapy. Am Fam Physician, 2017, 95(5): 295-302.
20. Jacobson BF, Louw S, Büller H, et al. Venous thromboembolism: prophylactic and therapeutic practice guideline. S Afr Med J, 2013, 103(4 Pt 2): 261-267.
21. Gonzalez-Fajardo JA, Arreba E, Castrodeza J, et al. Venographic comparison of subcutaneous low-molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis. J Vasc Surg, 1999, 30(2): 283-292.
22. Büller HR, Gent M, Gallus AS, et al. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. The Columbus Investigators. N Engl J Med, 1997, 337(10): 657-662.
23. 李文东, 李晓强, 钱爱民, 等. 下肢深静脉血栓形成治疗进展. 中国实用外科杂志, 2014, 34(12): 1190-1193.
24. Ma C, Zhang Y, Xu Q, et al. Influence of warfarin dose-associated genotypes on the risk of hemorrhagic complications in Chinese patients on warfarin. In J Hematol, 2012, 96(6): 719-728.
25. Ridker PM, Goldhaber SZ, Danielson E, et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med, 2003, 348(10): 1425-1434.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and treatment analysis of acute deep venous thrombosis at lower extremity of 98 aged patients

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