深い静脈栓塞と肺栓塞
Marcello Di Nisio1, Nick van Es2, Harry R Büller2
1Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University, Chieti, Italy; Department of Vascular Medicine, Academic Medical Centre, Amsterdam, Netherlands.
Lancet (London, England)
|July 5, 2016
まとめ
静脈血栓塞栓症 (VTE) の診断には,臨床規則とD- ダイマー検査が必要です. 直接投与される抗凝固剤は好ましい治療法であり,高リスクの患者には長期治療が検討される.
科学分野:
- 医学について
- 心臓病科
- 血液学
背景:
- 静脈血栓塞栓症 (VTE) は,深静脈血栓症と肺栓塞症を含む,世界的な健康上の大きな課題です.
- 現在,VTEの疑いに対する診断戦略は,臨床決定規則とD-ディマー検査を組み合わせた段階的なアプローチを伴う.
研究 の 目的:
- 静脈血栓塞栓症の診断と管理のガイドラインを概説する.
- 直接投与される抗凝固剤の第一線療法としての役割を強調し,治療期間について議論する.
主な方法:
- VTEを排除するために,臨床決定規則とD-ダイマー検査を順次適用する.
- 深静脈栓塞の疑いに対する超音波検査と肺栓塞の疑いに対するCTスキャン
- 治療の有効性と安全性について,直接投与される抗凝固剤とビタミンK抗剤の比較
主要な成果:
- 静脈動脈炎の可能性が低い患者で,正常なD- ダイマーは画像検査と抗凝固治療を安全に避けることができます.
- 直接投与される抗凝固剤は,ビタミンK抗剤と比較して,出血のリスクが低く,使用性が向上しています.
- 血動力学的に不安定な肺栓塞の症例に限定されています.
結論:
- 診断経路は,さらなる調査と治療を放棄できる患者を効果的に特定します.
- 直接投与される抗凝固剤は,VTEの初期治療法として好ましい.
- 少なくとも3ヶ月の抗凝固療法が推奨され,再発と出血の個々のリスク評価に基づいて,治療期間を延長することが検討されます.
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