| Deep venous thrombosis(DVT)mainly refers to the abnormal coagulation of blood in the deep venous lumen,which blocks the venous lumen and eventually leads to venous reflux disorder,which is often found in the lower extremities.Its potential complication Pulmonary embolism(PE)is the third common cause of acute death after coronary heart disease and stroke.DVT and PE together are called venous thromboembolism(VTE).The inferior vena cava filter(IVCF)is a device placed in the inferior vena cava in order to prevent the deadly PE caused by the thrombosis of the inferior vena cava(IVC)system and deep vein of lower limbs.Long-term IVCF indwelling can lead to related complications,including filter rupture,displacement,perforation of inferior vena cava,thrombosis or occlusion of inferior vena cava,recurrence of PE,recurrence of DVT and post-thrombotic syndrome(PTS),etc.,which seriously affect the quality of life of patients and even their life.The simplest way to prevent and treat the above complications is to recover the filter.After risk-benefit evaluation,the Food and DrugAdministration(FDA)suggested that patients with a recyclable filter should be recovered 29 to 54 days after the PE risk was eliminated,but the recovery rate was only about 30% in related reports.Anticoagulant therapy is the treatment of patients with DVT and/or PE basic treatment of anticoagulation therapy after IVCF lien has lower recurrence of DVT and PE trend,some studies suggest that for patients with long-term indwelling IVCF anticoagulation for 1 year or longer,although reports of IVCF retrospective literature more abroad,but domestic placing IVCF DVT patients recovery rate,the influence factors of not recycling what and how the anticoagulant compliance of patients with long-term indwelling IVCF,few related research reports.Objective:This study through retrospective chongqing a grade III-A hospital cases of DVT patients placing IVCF data for five consecutive years,the collection of the patient 's general information,Understand the cause of the placement of inferior vena cava filter to process the and anticoagulant medications,Analysis of the main influencing factors of the failure to recover the inferior vena cava filter and the failure to apply anticoagulant drugs,It provides clinical basis for long-term standardized diagnosis and treatment and follow-up of patients with long-term inferior vena cava filter implantation.Methods:Retrospective analysis the clinical data of placing IVCF patients from2012 to 2016,Include general information,thrombosis,type,filter types,the causes for the resettlement,recycling status,etc.Follow-up was conducted for patients who had not recovered IVCF,including the reasons for not recovering IVCF,whether they knew the possible risks of long-term indwelling IVCF,and the situation of anticoagulant medication.The influencing factors of IVCF not recovered and not given anticoagulant drugs were analyzed.EpiData 3.2 software was used for data entry,and SPSS 23.0 software was used for statistical analysis.Statistical methods included descriptive analysis and chi-square test,and P < 0.05 was considered statistically significant.Results:1.Overall arrangement of IVCF.The IVCF placement rate was26.84%(806/3003).Among the patients who were placed in IVCF,PE combined accounted for 38.71%(312/806),and PE prevention accounted for 61.29%(494/806).Among the patients receiving IVCF prophylaxis,27.05%(218/806)did not require further surgical treatment(no anticoagulation contraindications).2.IVCF not recycling situation and influencing factors..The overall recovery rate of the filter was 22.21%(179/806),and the recovery time was13.65± 4.19 days.The top five risk factors for unrecovered filters were fearof PE risk(40.72%),aging(34.54%),failure to recover after complications(20.88%),economic difficulties(13.66%),and tumor complications(12.11%).The IVCF recovery was statistically significant(P 0.01)for patients with different age stratification,malignant tumor and different departments.3.Anticoagulant status of patients with long-term indwelling IVCF.After 388 patients with long-term indwelling IVCF were discharged from hospital,301 patients(77.58%)insisted on anticoagulant medication,and the anticoagulant drugs were mainly rivaroxaban and warfarin.The longest duration of anticoagulant medication was 53 months and the shortest was January(median: September).Discontinuation of anticoagulants: 162 patients(53.82%)were discontinued as prescribed,134patients(44.52%)were discontinued on their own,and 5 patients(1.66%)were discontinued with severe complications.Reasons for not receiving anticoagulant therapy ranked top three: economic factors(40.23%),inconvenient transportation(32.18%),and unknown need for anticoagulant medication(17.24%).Patients with different payment methods of medical expenses and different levels of education had statistical significance in whether they received anticoagulant therapy or not(P<0.05)?Conclusion:1.The indications of IVCF in patients with DVT were toowide.In patients with preventive IVCF,the placement indications were too wide for DVT patients without further surgery(no anticoagulation contraindications.At the same time,with the further clinical understanding of VTE and filter application and the guidelines and norms,the rate of preventive placement of IVCF decreased.2.The main influencing factors of low IVCF recovery include: risk of PE recurrence,aging,and complications.The low recovery rate of IVCF was related to the patients' fear of PE recurrence,aging,the combination of malignant tumor,the occurrence of complications,and the medical staff's awareness of IVCF,etc.Medical staff should carefully evaluate the benefits and risks of long-term indwelling IVCF and improve the recovery rate of IVCF.3.Economic status and cognitive deficiency are the main factors affecting the anticoagulant treatment of patients with long-term indwelling IVCF.Nearly 1/3 of patients with long-term IVCF were unaware of the need for long-term anticoagulant treatment after discharge,so they never received anticoagulant treatment or stopped taking the medicine on their own,suggesting that medical staff should strengthen the health education of VTE patients before discharge to improve their medication compliance.For the situation that the anticoagulant treatment is affected by economic difficulties and inconvenient transportation,relevanttraining for primary doctors can be strengthened,their correct cognition of warfarin anticoagulant treatment can be enhanced,and convenient and accessible access to medical treatment can be provided for patients. |
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