冠心病介入术后并发深静脉血栓5例分析及经验总结

Deep Vein Thrombosis after Coronary Intervention:Analysis and Summary of 5 Cases

目的探讨冠心病介入术后并发深静脉血栓的临床特点、治疗及预后。方法收集2018年5—9月5例冠心病介入术后并发深静脉血栓患者的临床及检验资料,观察临床疗效。结果5例患者均因介入术中并发症,延长制动或局部压迫时间,无相关临床症状,因监测D-二聚体升高,发现深静脉血栓。初始抗凝予7~14 d肝素静脉泵入,D-二聚体下降至1μg·mL^(-1)以下,开始口服华法林至3个月。高出血风险患者,华法林+双联抗血小板三联1个月,继而华法林+氯吡格雷抗栓。术后3~4个月随访时深静脉血栓均消失,抗凝期间无出血事件发生。结论介入术后深静脉血栓发生的主要危险因素为局部压迫及制动造成的静脉血流缓慢,术后监测D-二聚体,有助于早期发现深静脉血栓。此类患者预后良好,初始肝素抗凝,继而华法林口服3个月,疗效及安全性良好。口服抗凝药期间应评估患者缺血和出血风险以确定抗血小板方案。

Objective To investigate the clinical features,treatment and prognosis of deep vein thrombosis after coronary intervention.Methods The clinical and laboratory data of 5 patients with deep vein thrombosis after coronary intervention performed from May to September 2018 were collected,and the clinical efficacy was observed.Results All the 5 patients were given prolonged immobilization or local compression due to the complications during interventional procedures.No patients had relevant clinical symptoms.Deep vein thrombosis was found due to increased D-dimer level.Heparin was pumped intravenously for 7-14 days for the initial anticoagulation.When the concentration of D-dimer decreased to less than 1μg·mL^(-1),warfarin was taken orally for 3 months.The patients at high bleeding risk were given warfarin and dual antiplatelet therapy for 1 month,followed by antithrombotic treatment with warfarin and clopidogrel.The deep vein thrombosis disappeared after 3-4 months of follow-up,and no bleeding events occurred during anticoagulation.Conclusion The main risk factor for deep vein thrombosis after interventional operation is slow venous blood flow caused by local compression and immobilization.Postoperative monitoring of D-dimer is helpful for early detection of deep vein thrombosis.Such patients have a good prognosis.The initial anticoagulation treatment with heparin and subsequent oral administration of warfarin for 3 months are associated with good efficacy and safety.During oral anticoagulation,the risks of ischemia and bleeding should be assessed to determine the antithrombotic regimen.