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Abstract：
Essentials Management of patients with calf deep vein thrombosis remains controversial. We conducted a post-hoc analysis of a placebo controlled LMWH randomized clinical trial. Pain was assessed using visual analogue scale at inclusion, one and six weeks. There was no difference in pain control between the two arms. SUMMARY: Background The optimal management of distal deep vein thrombosis (DVT) is highly debated. The only available placebo-controlled trial suggested the absence of clear benefit of anticoagulation. Many physicians feel that, beyond preventing thromboembolic complications, anticoagulation with low-molecular-weight heparin (LMWH) has the potential to improve pain control. Objectives To analyze whether LMWHs decrease pain in patients with distal deep vein thrombosis. Patients and methods Two-hundred and fifty-two patients included in a multicenter, placebo-controlled, randomized clinical trial of LMWH in patients with acute distal DVT and who were asked to rate their pain at inclusion and at each medical visit, using a visual analogue pain scale (VAS). Results One hundred and thirty patients were randomized in the therapeutic nadroparin arm and 122 patients were randomized in the placebo arm. Mean VAS values were 4.6 (standard deviation [SD] 2.5) at inclusion, 2.1 (SD 2.0) at 1 week and 0.4 (SD 1.2) at 6 weeks. We calculated the individual variation in VAS between inclusion and 1 week in patients in whom VAS was available at the two study time-points. There was no difference in the mean VAS reduction between patients treated with therapeutic nadroparin (n = 106) and with placebo (n = 109): -2.6 (SD 2.4) vs. -2.3 (SD 2.0) after 1 week and -4.4 (SD 2.8) vs. -4.0 (SD 2.4) after 6 weeks, respectively. The use of compression stockings was associated with a reduction in pain. Conclusion These data suggests that LMWH use does not improve pain control as compared with placebo in patients with acute distal DVT.
摘要：
要点小腿深静脉血栓形成患者的管理仍存在争议。我们对安慰剂对照的LMWH随机临床试验进行了事后分析。纳入时使用视觉模拟量表评估疼痛，一个和六个星期。两臂之间的疼痛控制没有差异。总结：背景远端深静脉血栓形成（DVT）的最佳管理存在很大争议。唯一可用的安慰剂对照试验表明，抗凝治疗缺乏明显的益处。许多医生认为，除了预防血栓栓塞并发症，低分子肝素(LMWH)抗凝有可能改善疼痛控制.目的分析LMWH对远端深静脉血栓形成患者疼痛的影响。患者和方法两百五十二患者纳入多中心，安慰剂对照,LMWH在急性远端DVT患者中的随机临床试验，并要求他们在纳入时和每次就诊时对疼痛进行评分。使用视觉模拟疼痛量表（VAS）。结果一百三十名患者在治疗性纳曲肝素组中被随机分配，122名患者在安慰剂组中被随机分配。包含时的平均VAS值为4.6（标准偏差[SD]2.5），2.1(SD2.0)在1周时和0.4(SD1.2)在6周时。我们计算了在两个研究时间点可获得VAS的患者在纳入和1周之间的VAS个体差异。用治疗性纳他帕林（n=106）和安慰剂（n=109）治疗的患者平均VAS降低没有差异：-2.6（SD2.4）与1周后-2.3（SD2.0）和-4.4（SD2.8）与-4.0（SD2.4）6周后，分别。使用压迫袜与疼痛减轻有关。结论这些数据表明，与安慰剂相比，使用LMWH并不能改善急性远端DVT患者的疼痛控制。
