LWMH与VKA对DVT患者院外抗凝效益-风险对比

Investigation on benefit-risk ratio in patients with deep venous thrombosis continued to be treated with anticoagulation outside hospital: Comparison on the clinical application between low molecule weight heparin and vitamin K antagonists

【目的】通过对经住院治疗后下肢深静脉血栓形成(deep venous thrombosis,DVT)患者院外分别继续应用低分子肝素(low molecule weight heparin,LMWH)或维生素K拮抗剂(vitamin K antagonists,VKA)的效益-风险比的对比研究,探讨较为有效、安全、简便的抗凝方案。【方法】将2008年12月-2011年3月符合纳入标准的患者随机分为A组(应用低分子肝素钙)和B组(应用华法林),并随访6个月,期间通过定期监测凝血功能及血小板计数,调整用药方案;每2个月做1次全面随访,包括有无出血、肝素诱导的血小板减少和复发事件的发生。【结果】两组均取得有效的抗凝效果,并且A组副作用发生率在各监测点明显低于B组(P<0.05),随访中发现两组DVT复发率无差异(P>0.05),但随着抗凝时间延长,两组患者出血发生率增加。在DVT复发患者中,髂股深静脉血栓形成者复发率最高,其次是股静脉、腘静脉。患者对应用A治疗方案的依从性较高。【结论】DVT患者院外继续应用LWMH抗凝效果可靠,用药安全性高,副作用较小,操作及监测简单,与应用VKA相比效益-风险比较高。

【Objective】 By comparing the benefit-risk ratioin patients with deep venous thrombosis（DVT）,continued to be treated with low molecule weight heparin（LMWH） or vitamin K antagonists（VKA）,to explore the more effective,safe and convenient therapeutic regimen.【Methods】 Patients fit the standard in this study from December 2008 to March 2011 were randomly divided into two groups.Patients in Group A were treated with Low-molecular-weight heparins calcium injection,and Warfarin in Group B.A follow-up visit was perpormed every two months for half a year,the content including whether there was bleed,heparin-induced thrombocytopenia（HIT）,and the recrudescence event occurs,in this period hemoglutination function and platelet count were monitored regularly,and according to the date to make adjustment in medication plan.【Results】 Effective anticoagulation was obtained in the two groups,and the incidence rate of side effect in group A was lower than that in group B obviously（P0.05）,but along with the anticoagulant time expand,the hemorrhage rate increasedin the two groups.However,in the DVT recrudescence patient.The rate in ilio-femoral vein was the highest,next was femoral vein,and finally was popliteal vein.Patient treated with LMWH revealed a better compliance.【Conclusion】 Using LWMH for patients with DVT outside hospital continuely revealed reliable result and high medication security,low side effect,simple operation and monitor,so it is better in benefit-risk than using VKA.