下肢深部静脈血栓症の臨床的検討—AHA-statementとの比較

Clinical Study of Ten Cases with Deep Vein Thrombosis of Lower Limbs

　肺血栓塞栓（PTE）の一大要因である下肢静脈血栓症（DVT）10例の治療をAHA勧告と比較した．Warfarin単独使用が5例，Heparin併用は5例であったが，そのHeparin投与日数は14日，Heparin初回量は2,000単位，維持量583単位／時で，HeparinはAHA勧告に比し極めて少量でしかも投与期間が長かった．Warfarin開始も遅く，Warfarin開始日は入院後10日目で導入量はl0mgであった．DVTと診断されるまでに24日もかかり長時間たっていることが問題である．入院期間も45日と圧倒的に長かった．DVTはBMIの大なるものに多く肥満は危険因子の一つと考えられる．10人中3人が整形外科術後に発生しており，整形外科にはDVT患者が潜在している可能性がある．DVTの治療には正確で迅速な診断と十分かつ適切な治療および初期管理が必須であると考えられる．

Deep vein thrombosis (DVT) is a major cause of pul-monary thromboembolism (PTE). Patients with DVT, however, will be relieved from risks of PTE by sufficient and effective initial management. The aim of this paper is to compare therapeutic modes for DVT among our ten cases of patients with DVT and those recorded in the American Heart Association (AHA) statement. Methods: We analysed ages, genders, periods of symp-toms to previous diagnosis, BMI, loading dose of warfar-in, bolus heparin, heparin maitenance dose, periods of heparinization, overlapping days of heparin and warfar-in administration and periods of hospitalization in ten cases of patients with DVT. Results : Subjects (Mean age 52.7 years, five males and five females) were divided into five patients of the non-heparinized warfarin ther-apy group and five patients of the overlapping heparin-warfarin group. It took twenty four days to finally diagnose the patients into these two groups. Basic dis-eases of the patients were hyperlipidemia, arithropaty, osteosarcoma, uterine myoma, fracture of the femoral neck, dilated cardiomyopathy, Raynaud's syndrome and polycystic kidneys. Three out of ten patients developed the DVT after orthopedic surgery. Increased BMI sug-gests that fatty people may be prone to develop DVT. Among our patients, bolus (2000IU vs 5000IU) and maitenance (580 IC vs 1333IU) dosages of heparin were much lower and heparinization and hospitalization periods were longer, compared with those recorded in the AHA-statement. Conclusion : The characteristics in our ten cases could be made, extensive delay until accurate diagnosis, lower dosage of heparin, longer heparinization and hospitalization. Early and adequate management of DVT is indispensable for the prevention of PTE.