[thorn]

Сообщение от angio

Интересно только то, чего я нигде не смог прочитать
а) насколько пациенты с кава-фильтром должны быть привержены к терапии антикоагулянтами?
б) нужна ли она на "неопределенно долгий срок"??
в) и можно ли ее "заменить" на ДААТ? - все-таки железка стоит не в артериальной системе, неужели она никогда не эндотелизируется???

Обычно рекомендуют на неопределенно долгий срок, но не очень уверенно... ИМХО в данной ситуации лучше отказаться от варфарина и идти на двойной терапии минимум год, а там посмотреть...

Greenfield LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters.J Vasc Surg. 2001 Mar;33(3):510-4.
Source
Department of Surgery, University of Michigan Hospital, Ann Arbor 48109, USA. [Ссылки доступны только зарегистрированным пользователям ]
Abstract
BACKGROUND:
Patients with venous thromboembolic disease are treated with anticoagulation or vena cava filter placement to prevent pulmonary embolism. A recent report suggested that filter placement may increase the risk of recurrent deep venous thrombosis (DVT) and prompted a review of our experience.
METHODS: Prospectively collected data on 2109 consecutive patients receiving filters were evaluated for recurrent thromboembolism, vena cava occlusion, or venous stasis ulceration. Outcomes were stratified and analyzed according to the use of anticoagulants at the time of insertion and at follow-up. Incidence rates were also compared with reports in the literature.
RESULTS: Of 1191 patients with DVT at filter placement, complete follow-up data at a mean of 9 years were available for 465. Recurrent DVT was found in 12% of the 241 patients who were given anticoagulants and 15% of the 224 who were not (P >.05). We also failed to find a significant association between the use of anticoagulation and the incidence of pulmonary embolism (2%), stasis ulceration (2%), and vena cava occlusion (0.0).
CONCLUSIONS: Recurrent DVT in patients with existing thromboembolic disease is not an unexpected event, which, in our experience, is not associated with anticoagulant or filter use. Anticoagulation should be used when possible to treat existing DVT to reduce thrombus progression and potentially to reduce subsequent complications but does not seem to reduce the rate of recurrent DVT. Rates of recurrent thromboembolism were consistently less than the 20% to 50% reported in the literature.

Poletti PA, Becker CD, Prina L, Ruijs P, Bounameaux H, Didier D, Schneider PA, Terrier F. Long-term results of the Simon nitinol inferior vena cava filter. Eur Radiol. 1998;8(2):289-94.
Source
Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, 24 Rue Micheli-du Crest, CH-1211 Geneva 14, Switzerland.
Abstract
The aim of this study was to evaluate the clinical efficacy, mechanical stability, and safety of the Simon nitinol inferior vena cava filter (SNF). The SNF was inserted in 114 consecutive patients at two institutions for prophylaxis of pulmonary embolism (PE). Clinical follow-up data were obtained retrospectively on all patients, and 38 patients underwent a dedicated radiologic follow-up protocol consisting of abdominal radiography, Doppler sonography, and CT. There was no immediate complication following filter insertion. Fifty patients died, on average, 5.6 (1-23) months after filter insertion, and 64 patients were alive, on average, 27 (3-62) months after filter insertion. Recurrent pulmonary embolism was documented in 5 patients (4.4 %) but originated distal to the filter in 1 patient. Deep venous thrombosis (DVT) was documented in 5.3 %, thrombosis at the access site in 3.5 %, and thrombosis of the inferior vena cava in 3.5 %. The rate of thromboembolic complications was similar in patients who did receive long-term anticoagulation and in those who did not. Radiologic follow-up showed no filter migration after, on average, 32 (5-62) months. A CT examination showed that struts of the SNF had penetrated the vena cava in 95 %, and were in contact with adjacent organs in 76 %; however, there were no clinical symptoms attributable to the filter. Filters were in an eccentric position in 63 % and partial filter disruption was found in 16 %; however, this did not affect filter function. The rate of recurrent pulmonary embolism after insertion of the SNF is 2.4 % per patient per year. Regardless of long-term anticoagulation, the rate of caval thrombosis is acceptably low. Except for occasional access-site thrombosis, no other filter-related morbidity was observed.