• 四川大學華西醫(yī)院老年科,成都,610041;

少有文獻報道心臟起搏器植入術后可能發(fā)生深靜脈血栓(deep venous thrombosis, DVT),但DVT會嚴重影響病人的預后和生活質量,并可導致更為致命的肺動脈栓塞.DVT的危險因素、治療策略和二級預防,各研究不盡相同.我們檢索了Cochrane Library,PubMed和Guideline網站上有關DVT的系統評價和隨機對照試驗.證據顯示,既往有DVT史、年齡＞40歲和有手術史是DVT的重要危險因素.肝素初始化治療和華法令在維持期的治療是必須和有效的,可改善病人的預后.對于發(fā)生過DVT的病人,在未來的高危狀態(tài)下,可用肝素和(或)口服抗凝劑進行預防性治療.

引用本文： 李峻,王雙,董碧蓉. 起搏器術后上肢深靜脈血栓形成的危險因素及其防治的臨床證據. 中國循證醫(yī)學雜志, 2004, 04(9): 652-656. doi: 復制

1. ［1］Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thromboembolism. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2002. 47.
2. ［2］Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, Wheeler HB. Prevention of venous thromboembolism[J]. Chest, 2001; 119(1 Suppl): 132S-175S.
3. ［3］Hansson PO, Eriksson H, Welin L, Svardsudd K, Wilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: "the study of men born in 1913"[J]. Arch Intern Med, 1999; 159(16): 1 886-1 890.
4. ［4］The Standards Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the prevention of venous thromboembolism[J]. Dis Colon Rectum, 2000; 43(8): 1 037-1 047.
5. ［5］Finnish Medical Society Duodecim. Edotpr-in-Chief Deep venous thrombosis[M]. Helsinki, Finland: Duodecim Medical Publications Ltd.; 2002. Various p.
6. ［6］The Database of Abstracts of Reviews of Effectiveness (University of York), Database No.: DARE-981801[M/CD]. In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software.
7. ［7］Antithrombotic therapy. A national clinical guideline. Edin-burgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 1999. 70.
8. ［8］Dolovich L, Ginsberg JS. Low molecular weight heparin in the treatment of venous thromboembolism: an updated meta-analysis[J]. Vessels, 1997; 3(1): 4-11.
9. ［9］Van den Belt AGM, Prins MH, Lensing AWA, Castro AA, Clark OAC, Atallah AN, Burihan E. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
10. ［10］Hirsh J, Fuster V, Ansell J, Halperin JL; American Heart As-sociation; American College of Cardiology Foundation. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy[J]. Circulation, 2003; 107(12): 1 692-1 711.
11. ［11］Hull RD, Delmore T, Carter C, Hirsh J, Genton E, Gent M, Turpie G, McLaughlin D. Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis[J]. N Engl J Med, 1982; 306(4): 189-194.
12. ［12］Ansell J, Hirsh J, Dalen J, Bussey H, Anderson D, Poller L, Jacobson A, Deykin D, Matchar D. Managing oral anticoagulant therapy[J]. Chest, 2001; 119(1 Suppl): 22S-38S.
13. ［13］Pinede L, Duhaut P, Cucherat M, Ninet J, Pasquier J, Boissel JP. Comparison of long versus short duration of anticoagulant therapy after a first episode of venous thromboembolism: a meta-analysis of randomized, controlled trials[J]. Journal of Internal Medicine, 2000; 247(5): 553-562.
14. ［14］Schulman S, Granqvist S, Holmstrom M, Carlsson A, Lindmarker P, Nicol P, Eklund SG, Nordlander S, Larfars G, Leijd B, Linder O, Loogna E. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism: Duration of Anticoagulation Trial Study Group[J]. N Engl J Med, 1997; 336(6): 393-398.
15. ［15］Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thromboembolism. Edinburgh: SIGN 1995. (SIGN publication no. 2).
16. ［16］Meyer G, Marjanovic Z, Valcke J, Lorcerie B, Gruel Y, Solal-Celigny P, Le Maignan C, Extra JM, Cottu P, Farge D. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study[J]. Arch Intern Med, 2002; 162(15): 1 729-1 735.
17. ［17］Samama MM. Epidemiology of risk factors of deep venous thrombosis(DVT) of the lower limbs in community practice: the SIRIUS study[J]. Thromb Haemost, 1993; 69(6): 763.
18. ［18］Hyers TM, Hull RD, Weg JG. Antithrombotic therapy for venous thromboembolic disease[J]. Chest, 1995; 108(4 Suppl): 335S-351S.
19. ［19］Brandjes DP, Heijboer H, Buller HR, de Rijk M, Jagt H, ten Cate JW. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis[J]. N Engl J Med, 1992; 327(21): 1 485-1 489.
20. ［20］Monreal M. Long-term treatment of venous thromboembolism: the place of low molecular weight heparin[J]. Vessels, 1997; 3(1): 18-21.
21. ［21］Mohiuddin SM, Hilleman DE, Destache CJ, Stoysich AM, Gannon JM, Sketch MH Sr. Efficacy and safety of early versus late initiation of warfarin during heparin therapy in acute thromboembolism[J]. Am Heart J, 1992; 123(3): 729-732.
22. ［22］Schulman S, Lockner D. Relationship between thromboembolic complications and intensity of treatment during long term prophylaxis with oral anticoagulants following DVT[J]. Thromb Haemost, 1985; 53(1): 137-140.
23. ［23］Harrison L, Johnston M, Massicotte MP, Crowther M, Moffat K, Hirsh J. Comparison of 5-mg and 10-mg loading dose in initiation of warfarin therapy[J]. Ann Intern Med, 1997; 126(2): 133-136.
24. ［24］Schulma S, Svenungsson E, Granqvist S. Anticardiolipin antibodies predict early recurrence of thromboembolism following anticoagulant therapy: Duration of Anticoagulation Study Group[J]. Am J Med, 1998; 104(4): 332-338.
25. ［25］Rance A, Emmerich J, Fiessinger JN. Anticardiolipin antibodies and recurrent thromboembolism[J]. Thromb Haemost, 1997; 77(1): 221-222.
  1. 1. ［1］Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thromboembolism. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2002. 47.
  2. 2. ［2］Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, Wheeler HB. Prevention of venous thromboembolism[J]. Chest, 2001; 119(1 Suppl): 132S-175S.
  3. 3. ［3］Hansson PO, Eriksson H, Welin L, Svardsudd K, Wilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: "the study of men born in 1913"[J]. Arch Intern Med, 1999; 159(16): 1 886-1 890.
  4. 4. ［4］The Standards Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the prevention of venous thromboembolism[J]. Dis Colon Rectum, 2000; 43(8): 1 037-1 047.
  5. 5. ［5］Finnish Medical Society Duodecim. Edotpr-in-Chief Deep venous thrombosis[M]. Helsinki, Finland: Duodecim Medical Publications Ltd.; 2002. Various p.
  6. 6. ［6］The Database of Abstracts of Reviews of Effectiveness (University of York), Database No.: DARE-981801[M/CD]. In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software.
  7. 7. ［7］Antithrombotic therapy. A national clinical guideline. Edin-burgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 1999. 70.
  8. 8. ［8］Dolovich L, Ginsberg JS. Low molecular weight heparin in the treatment of venous thromboembolism: an updated meta-analysis[J]. Vessels, 1997; 3(1): 4-11.
  9. 9. ［9］Van den Belt AGM, Prins MH, Lensing AWA, Castro AA, Clark OAC, Atallah AN, Burihan E. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
  10. 10. ［10］Hirsh J, Fuster V, Ansell J, Halperin JL; American Heart As-sociation; American College of Cardiology Foundation. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy[J]. Circulation, 2003; 107(12): 1 692-1 711.
  11. 11. ［11］Hull RD, Delmore T, Carter C, Hirsh J, Genton E, Gent M, Turpie G, McLaughlin D. Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis[J]. N Engl J Med, 1982; 306(4): 189-194.
  12. 12. ［12］Ansell J, Hirsh J, Dalen J, Bussey H, Anderson D, Poller L, Jacobson A, Deykin D, Matchar D. Managing oral anticoagulant therapy[J]. Chest, 2001; 119(1 Suppl): 22S-38S.
  13. 13. ［13］Pinede L, Duhaut P, Cucherat M, Ninet J, Pasquier J, Boissel JP. Comparison of long versus short duration of anticoagulant therapy after a first episode of venous thromboembolism: a meta-analysis of randomized, controlled trials[J]. Journal of Internal Medicine, 2000; 247(5): 553-562.
  14. 14. ［14］Schulman S, Granqvist S, Holmstrom M, Carlsson A, Lindmarker P, Nicol P, Eklund SG, Nordlander S, Larfars G, Leijd B, Linder O, Loogna E. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism: Duration of Anticoagulation Trial Study Group[J]. N Engl J Med, 1997; 336(6): 393-398.
  15. 15. ［15］Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thromboembolism. Edinburgh: SIGN 1995. (SIGN publication no. 2).
  16. 16. ［16］Meyer G, Marjanovic Z, Valcke J, Lorcerie B, Gruel Y, Solal-Celigny P, Le Maignan C, Extra JM, Cottu P, Farge D. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study[J]. Arch Intern Med, 2002; 162(15): 1 729-1 735.
  17. 17. ［17］Samama MM. Epidemiology of risk factors of deep venous thrombosis(DVT) of the lower limbs in community practice: the SIRIUS study[J]. Thromb Haemost, 1993; 69(6): 763.
  18. 18. ［18］Hyers TM, Hull RD, Weg JG. Antithrombotic therapy for venous thromboembolic disease[J]. Chest, 1995; 108(4 Suppl): 335S-351S.
  19. 19. ［19］Brandjes DP, Heijboer H, Buller HR, de Rijk M, Jagt H, ten Cate JW. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis[J]. N Engl J Med, 1992; 327(21): 1 485-1 489.
  20. 20. ［20］Monreal M. Long-term treatment of venous thromboembolism: the place of low molecular weight heparin[J]. Vessels, 1997; 3(1): 18-21.
  21. 21. ［21］Mohiuddin SM, Hilleman DE, Destache CJ, Stoysich AM, Gannon JM, Sketch MH Sr. Efficacy and safety of early versus late initiation of warfarin during heparin therapy in acute thromboembolism[J]. Am Heart J, 1992; 123(3): 729-732.
  22. 22. ［22］Schulman S, Lockner D. Relationship between thromboembolic complications and intensity of treatment during long term prophylaxis with oral anticoagulants following DVT[J]. Thromb Haemost, 1985; 53(1): 137-140.
  23. 23. ［23］Harrison L, Johnston M, Massicotte MP, Crowther M, Moffat K, Hirsh J. Comparison of 5-mg and 10-mg loading dose in initiation of warfarin therapy[J]. Ann Intern Med, 1997; 126(2): 133-136.
  24. 24. ［24］Schulma S, Svenungsson E, Granqvist S. Anticardiolipin antibodies predict early recurrence of thromboembolism following anticoagulant therapy: Duration of Anticoagulation Study Group[J]. Am J Med, 1998; 104(4): 332-338.
  25. 25. ［25］Rance A, Emmerich J, Fiessinger JN. Anticardiolipin antibodies and recurrent thromboembolism[J]. Thromb Haemost, 1997; 77(1): 221-222.