静脈血栓塞栓症
Faizan Khan1, Tobias Tritschler2, Susan R Kahn3
1School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Lancet (London, England)
|May 13, 2021
まとめ
静脈血栓塞栓症 (VTE) は 世界中で何百万人もの人に 影響しています 診断は,臨床スコア,D-ダイマー検査,画像検査を併用し,直接の経口抗凝固剤を主な治療法とする.
科学分野:
- 心臓病科
- 血液学
- 内科 医学
背景:
- 静脈血栓塞栓症 (VTE) は,深静脈血栓症と肺栓塞症を含んでおり,毎年数百万人に影響を与える重要な世界的な健康問題です.
- 大規模な手術やがんが 強い危険因子である一方で,多くのVTEは 誘発されていない.
- 現在の診断方法は,臨床的確率評価,D-ディマー検査,画像検査です.
研究 の 目的:
- 静脈血栓塞栓症の診断,治療,予防について概要を述べる.
- 静脈血栓炎の管理における直接経口抗凝固剤 (DOAC) の役割を強調する.
- 静脈動脈炎の治療における進行中の研究方向について議論する.
主な方法:
- 臨床スコア (例えばウェルズスコア),D-ダイマー検査,画像検査 (超音波検査,CT,V/Qスキャン) を含む連続診断検査
- がん患者を含むほとんどのVTE患者にとって,直接投与される口服抗凝固剤 (DOAC) の第一線治療です.
- 誘発されたイベントの3〜6ヶ月後に中止,高リスクまたは誘発されていないVTEの無期限の治療.
主要な成果:
- 臨床的確率が低く,D- ダイマーが正常な患者では,VTEは排除できる.
- ほとんどすべてのVTE症例では,DOACが推奨される第一線療法です.
- 抗凝固治療の期間は,誘発因子と再発リスクと出血リスクに基づいて個別化されます.
結論:
- 静脈動脈炎の効果的な診断には 多段階のアプローチが必要です
- DOACは現代のVTE治療の基石です
- 将来の研究は,診断ツールを改良し,抗凝固剤を比較し,VTEの予防と管理戦略をパーソナライズすることを目指しています.
関連する概念動画
01:30Venous Thrombosis I: Introduction
101
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
101
01:29Venous Thrombosis III: Interprofessional Care
88
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
88
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
88
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
88
01:29Pulmonary Embolism I: Introduction
210
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
210
01:30Venous Thrombosis IV: Nursing Management
66
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
66
01:27Pulmonary Embolism III: Nursing Management
105
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
105