一位70歲女性下肢深靜脈栓塞經抗凝血劑治療後嚴重腫脹

A 70-year-old Female with Deep VenousThrombosis Developing Severe Swelling after Anticoagulation Therapy

深靜脈栓塞是由於血栓在深靜脈形成，抗凝血劑是深靜脈栓塞的主要治療方式。本文為70歲女性個案，右小腿腫脹痛3天至急診求治，初診斷為下肢深靜脈栓塞（Deep Vein Thrombosis, DVT），因抗凝血劑使用過度導致嚴重腫脹並引發急性腔室症候群，期間活化部分凝血酶元時間（aPTT）大於120秒，下肢電腦斷層檢查發現是血腫所致，緊急接受筋膜切開手術治療。當個案使用傳統肝素抗凝血治療時，必須嚴格監控aPTT值並調整輸注速率，否則可能引發出血併急性腔室症候群。

 

Deep vein thrombosis (DVT) is the formation of blood clots (thrombus) in the deep veins. Anticoagulation therapy is the primary treatment for DVT. A 70-year-old woman was admitted to our Emergency Department due to a 3-day history of pain and swelling in the right leg. She was initially diagnosed to have DVT, but severe leg swelling with acute compartment syndrome developed after anticoagulation therapy. Her activated partial thromboplastin time (aPTT) was more than 120 seconds. A computer tomography scan of her lower limb showed the cause to be hematoma, which was then treated with fasciotomy. To avoid heparin related complications such as hematoma, aPTT should be carefully monitored and heparin dosage should be adjusted for risk factors.