.: ORİJİNAL ARAŞTIRMA
Ayak Venleri Yoluyla Uygulanan Trombolitik Tedavinin Alt Ekstremite Akut ve Subakut Derin Ven Trombozunda Etkinliği
Effificacy of Thrombolytic Therapy Applied Through Foot Veins in Lower Extremity Acute and Subacute Deep Vein Thrombosis
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(2):84-92
doi: 10.5336/cardiosci.2018-63205
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Akut dönemde mortal olabilen ve uzun vadede yaşam kalitesini etkileyen komplikasyonları nedeni ile derin ven trombozu (DVT) önemli bir sağlık sorunudur. DVT'nin tedavisinde kullanılan doku plazminojen aktivatörü (t-PA)'nün pedal venler yolu ile uygulanmasının hem akut hem subakut DVT tedavisindeki etkinliğinin sunulmasıdır. Gereç ve Yöntemler: Akut ve subakut DVT tanısı alan 83 hastanın pedal venlerine 18 G yeşil branül yerleştirildi. 10 mg t-PA branülden bolus şeklinde uygulandıktan sonra 1 mg/saat dozunda 48-72 saat infüzyon olarak verildi. Kırk sekizinci saat sonunda, 3. 6. ve 12. aylarda doppler ultrasonografi (USG) çekilerek tedavi edilen derin venin akım durumu, reflü süreleri değerlendirildi. Klinik iyileşme için "venous clinical severity score (VCSS)" ve posttrombotik sendrom (PTS) açısından Villalta skorlamaları yapıldı. Bulgular: Akut DVT grubunda 44 (26 erkek), subakut DVT grubunda ise 39 (24 erkek) hasta çalışmaya dâhil edildi. Akut grupta 56,4±11,3 mg t-PA 52,3±9,3 saatte, subakut grupta 71,7±14,3 mg t-PA (0,001) 60,3 ±12,1 saatte (0,012) uygulandı. Kırk sekizinci saatte total açılma oranı akut grupta %82 (36 hasta), subakut grupta %43 (19 hasta) idi. On ikinci ayda VCSS ve Villalta skorları akut grupta 3,6±1,8 ve 2,4±1,9 ve subakut grupta 5,8±2,6, 4,3±2,2 olarak hesaplandı (0,008/0,001). Subakut grupta 7 (%18), akut grupta 2 (%4,5) hastada femoropopliteal segmentte asemptomatik DVT nüksü saptandı. Toplamda 14 (%16,8) hastada ise PTS bulguları mevcuttu. Sonuç: Anjiyografi ünitesi ve USG gerektirmemesi, kolay uygulanması ve noninvaziv olması nedeni ile bölgesel trombolitik tedavi yönteminin, seçilmiş hastalarda, DVT'nin invaziv olan trombolitik tedavilerine iyi bir alternatif olduğu düşünülmektedir.
Anahtar Kelimeler: Derin ven trombozu; t-PA; trombolitik tedavi; posttrombotik sendrom
Amaç: Akut dönemde mortal olabilen ve uzun vadede yaşam kalitesini etkileyen komplikasyonları nedeni ile derin ven trombozu (DVT) önemli bir sağlık sorunudur. DVT'nin tedavisinde kullanılan doku plazminojen aktivatörü (t-PA)'nün pedal venler yolu ile uygulanmasının hem akut hem subakut DVT tedavisindeki etkinliğinin sunulmasıdır. Gereç ve Yöntemler: Akut ve subakut DVT tanısı alan 83 hastanın pedal venlerine 18 G yeşil branül yerleştirildi. 10 mg t-PA branülden bolus şeklinde uygulandıktan sonra 1 mg/saat dozunda 48-72 saat infüzyon olarak verildi. Kırk sekizinci saat sonunda, 3. 6. ve 12. aylarda doppler ultrasonografi (USG) çekilerek tedavi edilen derin venin akım durumu, reflü süreleri değerlendirildi. Klinik iyileşme için "venous clinical severity score (VCSS)" ve posttrombotik sendrom (PTS) açısından Villalta skorlamaları yapıldı. Bulgular: Akut DVT grubunda 44 (26 erkek), subakut DVT grubunda ise 39 (24 erkek) hasta çalışmaya dâhil edildi. Akut grupta 56,4±11,3 mg t-PA 52,3±9,3 saatte, subakut grupta 71,7±14,3 mg t-PA (0,001) 60,3 ±12,1 saatte (0,012) uygulandı. Kırk sekizinci saatte total açılma oranı akut grupta %82 (36 hasta), subakut grupta %43 (19 hasta) idi. On ikinci ayda VCSS ve Villalta skorları akut grupta 3,6±1,8 ve 2,4±1,9 ve subakut grupta 5,8±2,6, 4,3±2,2 olarak hesaplandı (0,008/0,001). Subakut grupta 7 (%18), akut grupta 2 (%4,5) hastada femoropopliteal segmentte asemptomatik DVT nüksü saptandı. Toplamda 14 (%16,8) hastada ise PTS bulguları mevcuttu. Sonuç: Anjiyografi ünitesi ve USG gerektirmemesi, kolay uygulanması ve noninvaziv olması nedeni ile bölgesel trombolitik tedavi yönteminin, seçilmiş hastalarda, DVT'nin invaziv olan trombolitik tedavilerine iyi bir alternatif olduğu düşünülmektedir.
Anahtar Kelimeler: Derin ven trombozu; t-PA; trombolitik tedavi; posttrombotik sendrom
ABSTRACT
Objective: Deep vein thrombosis (DVT) is an important health problem because of its complications that may be mortal in the acute period and affect the quality of life in the long term. We aimed to present the effectiveness of tissue plasminogen activator (t-PA) via pedal veins in the treatment of both acute and subacute DVT. Material and Methods: Eighteen G green tubules were placed in the pedal veins of 83 patients with acute and subacute DVT. First, 10 mg t-PA bolus was applied as bolus and then was given intravenous infusion at 1 mg/h for 48-72 hours. At the end of 48th hour, the thrombus was evaluated with Doppler ultrasonography (USG). Treated deep vein current status and reflux time was evaluated by USG at months 3, 6, and 12. Venous clinical severity score (VCSS) was performed for evaluating of clinical improvement and Villalta scoring was performed at the same time in terms of post thrombotic syndrome (PTS). Results: Forty four patients (26 men) in the acute DVT group and 39 (24 men) patients in the subacute DVT group were included in the study. In the acute group 56.4±11.3 mg t-PA and in the subacute group 71.7±14.3 mg t-PA (0.001) were administered in 52.3±9.3 and 60.3±12.1 hours (0.012) respectively. The total recanalization rate was 82% (36 patients) in the acute group and 43% (19 patients) in the subacute group at the end of 48th hour. At the 12-month follow-up, VCSS and Villalta scores were calculated as 3.6 ± 1.8 and 2.4±1.9 in the acute group, and as 5.8±2.6 and 4.3±2.2 in the subacute group (0.008/0.001). DVT recurrence which was asymptomatic was observed 7 (18%) patients in subacute group and 2 (4.5%) patients in the acute group. In total 14 (16,8%) patients had PTS findings. Conclusion: Because of easy application and being noninvasive and no need for angiography unit and USG, regional thrombolytic therapy is a good alternative treatment for selected patients in whom invasive thrombolytic therapy of DVT is not performed.
Keywords: Deep vein thrombosis; t-PA; thrombolytic therapy; postthrombotic syndrome
Objective: Deep vein thrombosis (DVT) is an important health problem because of its complications that may be mortal in the acute period and affect the quality of life in the long term. We aimed to present the effectiveness of tissue plasminogen activator (t-PA) via pedal veins in the treatment of both acute and subacute DVT. Material and Methods: Eighteen G green tubules were placed in the pedal veins of 83 patients with acute and subacute DVT. First, 10 mg t-PA bolus was applied as bolus and then was given intravenous infusion at 1 mg/h for 48-72 hours. At the end of 48th hour, the thrombus was evaluated with Doppler ultrasonography (USG). Treated deep vein current status and reflux time was evaluated by USG at months 3, 6, and 12. Venous clinical severity score (VCSS) was performed for evaluating of clinical improvement and Villalta scoring was performed at the same time in terms of post thrombotic syndrome (PTS). Results: Forty four patients (26 men) in the acute DVT group and 39 (24 men) patients in the subacute DVT group were included in the study. In the acute group 56.4±11.3 mg t-PA and in the subacute group 71.7±14.3 mg t-PA (0.001) were administered in 52.3±9.3 and 60.3±12.1 hours (0.012) respectively. The total recanalization rate was 82% (36 patients) in the acute group and 43% (19 patients) in the subacute group at the end of 48th hour. At the 12-month follow-up, VCSS and Villalta scores were calculated as 3.6 ± 1.8 and 2.4±1.9 in the acute group, and as 5.8±2.6 and 4.3±2.2 in the subacute group (0.008/0.001). DVT recurrence which was asymptomatic was observed 7 (18%) patients in subacute group and 2 (4.5%) patients in the acute group. In total 14 (16,8%) patients had PTS findings. Conclusion: Because of easy application and being noninvasive and no need for angiography unit and USG, regional thrombolytic therapy is a good alternative treatment for selected patients in whom invasive thrombolytic therapy of DVT is not performed.
Keywords: Deep vein thrombosis; t-PA; thrombolytic therapy; postthrombotic syndrome
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