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静脈 血栓 栓塞: 診断 と 治療 の 進歩
Tobias Tritschler1, Noémie Kraaijpoel2, Grégoire Le Gal3,4
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
JAMA
|October 17, 2018
まとめ
静脈血栓塞栓症 (VTE) の 診断 と 治療 の 進歩 は 治療 を 簡素 に し て い ます. 新しい戦略により,深静脈血栓症 (DVT) と肺栓塞 (PE) の個別化管理が可能になり,安全性と結果が向上します.
科学分野:
- 心血管医学
- 血液学
- 医療診断
背景:
- 静脈血栓塞栓症 (VTE) は,深静脈血栓症 (DVT) と肺栓塞症 (PE) を含む,世界的な健康上の重大な負担を伴う.
- 発症率と死亡率の可能性があるため,VTEの効果的な管理は極めて重要です.
研究 の 目的:
- 過去5年間のVTEの診断と治療における最近の進歩の包括的な要約を提供すること.
- 静脈動脈炎の管理における臨床実践と治療方法における重要な変化を強調する.
主な方法:
- 2013年1月から2018年7月に出版された研究について,主要な生物医学データベース (EMBASE, MEDLINE) で体系的な文献検索が行われました.
- 臨床ガイドラインのスクリーニングで補完された,系統的レビュー,メタ解析,ランダム化制御試験,および前向きなコホート研究が含まれていました.
主要な成果:
- 年齢に応じて調整されたD- ダイマー値と肺栓塞排除基準は,PEの診断の正確性を高め,イメージングの必要性を軽減します.
- 経口直接抗凝固剤 (DOAC) は,血液出血のリスクを低減し,二次予防の延長を促進する,簡素化されたVTE治療を提供します.
- 血栓溶解は,大規模なPEまたは四肢を脅かすDVTに留まっています. 下 vena cavaフィルターは,抗凝固薬が禁忌である場合にのみ示されています. 段階的な圧縮ストッキングは,DVTの治療には推奨されませんが,症状を緩和することができます.
結論:
- 静脈動脈炎の管理に 重要な進展がみられ, 適応型の診断と治療戦略が可能になりました.
- 現在のアプローチでは,VTEの管理における個人の特徴,好み,価値観を考慮して,個別化された患者のケアを可能にします.
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