Rezultatele la distanță ale managementului convențional al trombozei venelor profunde (TVP) a membrelor inferioare
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Патология сердечно-сосудистой системы. Сердечно-сосудистые заболевания (1025)
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, , CULIUC, Vasile, , , CASIAN, Dumitru, BZOVÎI, Florin, DONŢU, Ion. Rezultatele la distanță ale managementului convențional al trombozei venelor profunde (TVP) a membrelor inferioare. In: Arta Medica , 2019, nr. 3(72), p. 87. ISSN 1810-1852.
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Arta Medica
Numărul 3(72) / 2019 / ISSN 1810-1852 /ISSNe 1810-1879

Rezultatele la distanță ale managementului convențional al trombozei venelor profunde (TVP) a membrelor inferioare

Long-term outcomes of the empiric management of deep vein thrombosis (DVT) of the lower limbs

CZU: 616.147.3-005.6-07

Pag. 87-87

1, Culiuc Vasile1, 1, Casian Dumitru1, Bzovîi Florin1, Donţu Ion2
 
1 Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“,
2 Spitalul Clinic Municipal nr. 1
 
 
Disponibil în IBN: 21 aprilie 2020


Rezumat

Introducere: În condițiile recente de organizare a asistenței medicale în Republica Moldova managementul bolnavilor cu TVP s-a realizat în mare parte convențional, considerând tradițiile Clinicilor și/sau viziunile personale ale medicilor. Scopul studiului a constat în evaluarea rezultatelor imagistico-clinice la distanță ale tratamentului convențional al TVP. Material și metode: Lotul cercetat a inclus 218 pacienți (222 membre) spitalizați pentru TVP(2006-2016); mediana vârstei – 58 ani, bărbați – 58,9%. TVP a fost conirmată în toate cazurile prin duplex scanare. Rezultate: Topograia procesului trombotic conform clasiicării Lower Extremity Thrombosis (LET): clasa I – 0,85%; II – 51,5%; III – 41,63%; IV – 6%. Intervenții chirurgicale pentru TVP lotantă au fost practicate în 26,5% observații. Terapia anticoagulantă s-a inițiat în mediu la 96 (25%-75%IQR 72–204) ore de la debutul simptomaticii; dozajul optim iind prescris doar pentru 1/4 din bolnavi. Anticoagularea de durată (34,19%) sau extinsă (60,17%) s-a realizat cu antagoniștii vitaminei K (90,82%), rivaroxaban (5,24%) sau heparine fracționate (3,93%); pe parcursul a 3–24 luni. Rata timpului anticoagulării terapeutice (INR: 2–3) a constituit 42,1%. Duplex scanarea venoasă peste 69,3±39,6 luni de la episodul trombotic a pus în evidență: relux+stenoză profundă (48,19%), absența sechelelor posttrombotice (22%), relux (20,72%), relux+ocluzie (5,4%), stenoză (2,25%), ocluzie (1,35%). Sindromul posttrombotic (scor Villalta ≥5 puncte) a fost diagnosticat în 64,8% cazuri; forma severă (scor Villalta ≥15 puncte) – în 23,8%. Duplex scanarea venoasă peste 69,3±39,6 luni de la episodul trombotic a pus în evidență: relux+stenoză profundă (48,19%), absența sechelelor posttrombotice (22%), relux (20,72%), relux+ocluzie (5,4%), stenoză (2,25%), ocluzie (1,35%). Sindromul posttrombotic (scor Villalta ≥5 puncte) a fost diagnosticat în 64,8% cazuri; forma severă (scori lVlalta ≥15 puncte) – în 23,8%. Concluzii: Tratamentul empiric al TVP se asociază cu o rată inacceptabil de înaltă a sechelelor posttrombotice. Implementarea amplă în practica medicală cotidiană a recomandărilor ghidului național ce vizează managementuTlV P reprezintă o necesitate stringentă.

Under the recent conditions of organizing healthcare in Republic of Moldova, the management of patients with DVT was largely empiric, considering the traditions of Clinics and/or personal experience of doctors. Aim of study was to assess the long-term duplex imaging and clinical results of conventional DV tTreatment. Material and methods: The surveyed group included 218 patients (222 extremities) hospitalized for DVT (2006-2016); median age – 58 years, males – 58.9%. DVT has been conirmed in all cases by duplex scanning. Results: Topography of thrombotic process according to Lower Extremity Thrombosis (LET) classiication: class I – 0.85%; II – 51.5%; III – 41.63%; IV – 6%. Surgical interventions for free-loating DVT were performed in 26.5% observations. Median time of anticoagulant therapy initiation was 96 (25%-75%IQR 72–204) hours after the onset of symptoms; optimal dosage being prescribed for only 1/4 of patients. Long-term (34.19%) or extended (60.17%) anticoagulation was carried out during 3–24 months; using vitamin K antagonists (90.82%), rivaroxaban (5.24%) or fractionated heparins (3.93%). The percentage of time spent within target INR range (2–3) was 42.1%. Venous duplex scanning over 69.3±39.6 months after the thrombotic episode revealed: deep relux+stenosis (48.19%), absence of postthrombotic sequelae (22%), relux (20.72%), relux+occlusion (5.4%), stenosis (2.25%), occlusion (1.35%). Postthrombotic syndrome (Villalta score ≥5 points) was diagnosed in 64.8% of cases; while the severe form (Villalta score ≥15 points) – in 23.8%. Conclusion: Empiric treatment of DVT is associated with an unacceptably high rate of postthrombotic sequelae. The broad implementation in daily medical practice of national guidelines for D VmTanagement constitutes a prsesing necessity.

Cuvinte-cheie
tromboza venelor profunde, management empiric,

deep vein thrombosis, empiric management

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<cfAbstr cfLangCode='RO' cfTrans='o'><p>Introducere: &Icirc;n condițiile recente de organizare a asistenței medicale &icirc;n Republica Moldova managementul bolnavilor cu TVP s-a realizat &icirc;n mare parte convențional, consider&acirc;nd tradițiile Clinicilor și/sau viziunile personale ale medicilor. Scopul studiului a constat &icirc;n evaluarea rezultatelor imagistico-clinice la distanță ale tratamentului convențional al TVP. Material și metode: Lotul cercetat a inclus 218 pacienți (222 membre) spitalizați pentru TVP(2006-2016); mediana v&acirc;rstei &ndash; 58 ani, bărbați &ndash; 58,9%. TVP a fost conirmată &icirc;n toate cazurile prin duplex scanare. Rezultate: Topograia procesului trombotic conform clasiicării Lower Extremity Thrombosis (LET): clasa I &ndash; 0,85%; II &ndash; 51,5%; III &ndash; 41,63%; IV &ndash; 6%. Intervenții chirurgicale pentru TVP lotantă au fost practicate &icirc;n 26,5% observații. Terapia anticoagulantă s-a inițiat &icirc;n mediu la 96 (25%-75%IQR 72&ndash;204) ore de la debutul simptomaticii; dozajul optim iind prescris doar pentru 1/4 din bolnavi. Anticoagularea de durată (34,19%) sau extinsă (60,17%) s-a realizat cu antagoniștii vitaminei K (90,82%), rivaroxaban (5,24%) sau heparine fracționate (3,93%); pe parcursul a 3&ndash;24 luni. Rata timpului anticoagulării terapeutice (INR: 2&ndash;3) a constituit 42,1%. Duplex scanarea venoasă peste 69,3&plusmn;39,6 luni de la episodul trombotic a pus &icirc;n evidență: relux+stenoză profundă (48,19%), absența sechelelor posttrombotice (22%), relux (20,72%), relux+ocluzie (5,4%), stenoză (2,25%), ocluzie (1,35%). Sindromul posttrombotic (scor Villalta &ge;5 puncte) a fost diagnosticat &icirc;n 64,8% cazuri; forma severă (scor Villalta &ge;15 puncte) &ndash; &icirc;n 23,8%. Duplex scanarea venoasă peste 69,3&plusmn;39,6 luni de la episodul trombotic a pus &icirc;n evidență: relux+stenoză profundă (48,19%), absența sechelelor posttrombotice (22%), relux (20,72%), relux+ocluzie (5,4%), stenoză (2,25%), ocluzie (1,35%). Sindromul posttrombotic (scor Villalta &ge;5 puncte) a fost diagnosticat &icirc;n 64,8% cazuri; forma severă (scori lVlalta &ge;15 puncte) &ndash; &icirc;n 23,8%. Concluzii: Tratamentul empiric al TVP se asociază cu o rată inacceptabil de &icirc;naltă a sechelelor posttrombotice. Implementarea amplă &icirc;n practica medicală cotidiană a recomandărilor ghidului național ce vizează managementuTlV P reprezintă o necesitate stringentă.</p></cfAbstr>
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