Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3656_Библиотеки_им_академика_М_И_Перельмана

case–control study tested 63 ‘low-risk’ patients (dened by the absence of malignancy, autoimmune disease, and lower extremity varicosities) for factor V Leiden muta­tion, prothrombin G20210A mutation, and deciencies in antithrombin III (AT III), protein C, and protein S.11 An increased risk of SVT was identied in patients with inher­ited coagulopathies. Risk of SVT was increased approxi­mately six-fold for factor V Leiden mutation, four-fold for the prothrombin G20210A mutation, and 13-fold for the combined factor deciencies. Similarly, de Moerloose et al. demonstrated that the presence of factor V Leiden mutation increased risk of SVT, although this was no lon­ger statistically signicant aer controlling for obesity.13 Additionally, patients with SVT not associated with lower extremity varicosities were more likely to have an inherited hypercoaguable state.

A 1999 prospective trial comparing various anticoagu­lant treatment groups (prophylactic unfractionated heparin, prophylactic low-molecular-weight heparin [LMWH], and therapeutic warfarin) to elastic compression alone or saphe­nous ligation identied lower rates of SVT extension in the anticoagulant treatment groups by surveillance imaging, without major bleeding complication.31 Several contempo­rary trials have followed, further supporting the benets of anticoagulation for SVT. e 2003 SVT Enoxaparin Study Group published their double-blind randomized trial com­paring 8 days of treatment for SVT with prophylactic enoxa­parin (40 mg) daily, therapeutic enoxaparin (1.5 mg/kg) daily, oral tenoxicam, and placebo for 8–12 days.32 e inci­dence of deep and supercial venous thromboembolism was signicantly decreased in all treatment groups (from 30.6% in the placebo group to 8.3% in the prophylactic enoxaparin group, 6.9% in the therapeutic enoxaparin group, and 14.9% in the tenoxicam group) without any hemorrhagic morbid­ity or heparin-induced thrombocytopenia. e randomized controlled Vesalio trial compared 1 month of prophylactic versus therapeutic doses of nadroparin for SVT.33 ese authors failed to demonstrate a dierence in thrombus pro­gression or VTE in either group, and moreover, they failed to meet recruitment goals, resulting in premature study termination.

Most recently, a 14-day treatment course of daltepa­rin (200 U/kg at presentation followed by 10,000 U daily) for SVT was identied as superior to ibuprofen (800 mg three times daily) for both major upper and lower SVT.35 Interestingly, this benet was lost by the 3-month follow­up, and thrombus extension, including VTE, occurred in the time period following cessation of dalteparin and ibuprofen dosing, suggesting the treatment duration (2 weeks) may have been too brief. Finally, both therapies signicantly reduced symptoms of pain during the treat­ment periodand appeared safewithout episodes of major or minor hemorrhage.