下肢静脈血栓塞栓症 の 診断 と 治療: レビュー
Romain Chopard1,2, Ida Ehlers Albertsen3,4, Gregory Piazza5
1Department of Cardiology, University Hospital Jean Minjoz, Besançon, France.
JAMA
|November 3, 2020
まとめ
深静脈栓塞 (DVT) のリスクは年齢とともに増加し,新しい抗凝固薬は有効です. 経口抗凝固剤はワルファリンと同じくらい有効ですが,出血のリスクは少なくなりますが,コストは障壁です.
科学分野:
- 血管医学
- 血液学
- クリニカル・トロンボシス研究
背景:
- 深静脈血栓症 (DVT) は10万人当たり88~112例で,年齢とともに増加しています.
- 再発性静脈血栓塞栓症 (VTE) の発生率は,発生後10年間で20~36%である.
- 危険因子には,高齢化,悪性腫瘍,炎症性疾患,遺伝性血栓性疾患などがあります.
研究 の 目的:
- DVT の危険因子に関する現在の理解を再考する.
- 下肢DVTの診断戦略を評価する.
- 現代の抗凝固治療の有効性と安全性を評価する.
主な方法:
- パブメドとコクランのデータベースの体系的な文献検索 (2015-2020).
- ランダム化臨床試験,メタ解析,体系的レビュー,観察研究が含まれています.
- 危険因子,診断方法 (D-ダイマー,ウェルズスコア,超音波検査),治療結果に焦点を当てました.
主要な成果:
- 急性VTEを除外するために,D-ダイマー試験とプレテストの確率評価補助剤を組み合わせた.
- DVTの診断から3~6ヶ月後,25~50%の患者で発症する.
- 直接投与される経口抗凝固剤 (DOAC) の有効性はワーファリンに劣らず,出血率が低かった (1. 1% 対 1. 8%).
結論:
- VTE の 危険因子 の 認識 と 抗凝固 薬 の 進歩 は,DVT の 管理 を 改善 し まし た.
- ウォルファリンと比較して,DOACは好ましい有効性と安全性プロファイルを提供します.
- 費用は,DOACの普及を考慮する要因です.
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