静脈性血栓塞栓症後の患者の長期的な管理
1Department of Medicine, McMaster University, McMaster Clinic, Henderson General Hospital, Hamilton, Ontario, Canada. kearonc@mcmaster.ca
Circulation
|September 2, 2004
まとめ
抗凝固剤治療期間を個別化することは,静脈血栓塞栓症 (VTE) の長期的な管理の鍵です. 治療の長さは,VTEの危険因子と出血の可能性に依存し,最適な患者の結果に関する決定を導く.
科学分野:
- 心臓病学 心臓病学
- 血液学 ヘマトロジ
- 薬理学 薬理学とは
背景:
- 静脈血栓塞栓症 (VTE) の長期的な管理は,主に抗凝固剤治療の最適な期間を決定することを含む.
- 現在のガイドラインでは,延長されたVTE治療のために,ビタミンK (VK) 反抗剤を使用することが多い.
研究 の 目的:
- VTE患者の長期抗凝固剤治療のための個別化された戦略を概説する.
- VTE再発リスクと出血リスクに基づいて治療期間を定義する.
主な方法:
- 誘発因子 (例えば,手術,がん,イディオパシー) に基づくリスクの階層化.
- 再発および出血に影響を与える臨床的要因 (例えば,肺栓塞,悪性腫瘍,患者の好み) を考慮する.
- VKアンタゴニスト療法のための最適な強度の定義 (ターゲットINR2.0-3.0).
主要な成果:
- 主要な可逆要因によって引き起こされたVTE:典型的には3ヶ月の治療.
- 誘発されていないVTEまたは不可逆的な要因 (がんなど) と関連している:少なくとも6ヶ月,しばしば無期限の治療.
- 中間リスクVTE: 3~6ヶ月の治療.
結論:
- 個別化されたVTE治療期間は,再発と出血のリスクをバランスをとって決定的です.
- 特定の臨床プレゼンテーションと患者の要因は,治療期間をガイドします.
- 低分子量ヘパリンおよび経口直接トロンビン阻害剤は,長期的なVTE予防の代替手段です.
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