The Clinical Study Of Prevention And Treatment In Lower Extremity Deep Venous Thrombosis

Object: Through analysis the risk factors of lower extremity deep venous thrombosis(LDVT), to provide clinic data for prophylaxis of lower extremity deep vein thrombosis. Through investigating the effects of the different protocols for treatment of LDVT, which basing on disease suffering time and application of thrombolysis or not, to provide the theoretical basis for clinical treatment for LDVT.Method: The clinic data of 401 patients of LDVT treated in our departments from 2004 to 2008 were reviewed. Totally 379 unilateral LDVT cases who received non-surgical therapy were enrolled, and were divided into three groups: acute stage(≤3days), subacute stage(3～14days) and chronic stage(>14days) group according to diseased time. Each group were more divided into two sub-groups according to therapeutic protocol: thrombolysis plus anti- coagulation and anticoagulation alone. Changes of the lower extremity circumference and variation of coagulation indexes were recorded in each group to measure the therapeutic effect. All data were treated with SPSS(12.0) statistical package.Result: The Number of patients with LDVT has been increasing year by year in past five years. About 95.5% patients with LDVT had definitive risk factors. The most common risk factors were: age over 40 years old(74.1%), operation history(42.1%), trauma(21.0%), cardiovascular disease(16.2%) and pregnancy (15.7%). 379 cases with unilateral LDVT were reviewed, and the patients in acute stage has better outcome; the clinical efficacy in thrombolysis plus anticoagulation subgroup has better than in anticoagulation alone subgroup (P<0.01), but no significant difference(P>0.05)in variation of coagulation indexes and complication rate among the subgroups. Moreover, the curative and obvious effective rate in thrombolysis plus anticoagulation subgroup (69%) was higher than in anticoagulation alone subgroup(35.4%). On summary, the curative and obvious effective rate with thrombolysis plus anticoagulation treatment in all the three groups were 84.2% in acute stage, 64.2% in subacute stage and 44.4% in chronic stage, respectively(P<0.01). The date of 158 patients with postoperative thrombosis of deep venous on unilateral lower extremities treated by non-surgical therapy were analyzed retrospectively: the curative and obvious effective rate was 73%, and the changes of circumferences of thigh and leg were 3.20±1.80cm and 4.12±2.43cm in thrombolysis plus anticoagulation group, respectively. In the anticoagulation alone group the curative and obvious effective rate was 42%, and extremities changes were 2.49±1.83cm and 2.79±1.97cm, there were significant differences between the two groups (P<0.01), but no significant difference(P>0.05)in variation of coagulation indexes and complication rate among the two groups.Conclusions:The incidence rate of LDVT increases year by year. This study shows that LDVT has the main risk factors including age over 40 years old, surgery, trauma, cardiovascular disease and pregnancy. The outcome of protocol with anticoagulant plus thrombolytic therapy was better than that with anticoagulation alone in LDVT, and those in acute stage has better outcome than in non-acute phase. For patients in non-acute stage phase, thrombolysis plus anticoagulation treatment were still effective. Thrombolysis plus anticoagulation is an effictive and safe method for postoperative LDVT, under the tight monitoring of clot relative parameters.