静脉血栓栓塞症后的抗凝固剂的持续时间:一个元分析
David Ost1, Josh Tepper, Hanako Mihara
1Center for Pulmonary and Critical Care Medicine, North Shore University Hospital, Manhasset, NY 11030, USA. dost@nshs.edu
JAMA
|August 11, 2005
概括
延长抗凝剂显著降低了复发性静脉血栓栓塞 (VTE) 的风险. 虽然在停止治疗后仍然存在益处,但保护作用会减弱,这表明长时间的抗凝药可以提供持续的VTE保护.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 临床医学 临床医学
背景情况:
- 静脉血栓栓塞 (VTE) 患者面临复发事件的高风险.
- 对VTE抗凝治疗的最佳持续时间是正在进行的辩论的主题.
研究的目的:
- 系统地审查有关延长VTE患者抗凝血持续时间的现有证据.
- 量化长期抗凝治疗的比较风险和益处.
主要方法:
- 在主要数据库 (PubMed,EMBase,Cochrane) 和临床试验注册表中进行了全面的文献搜索.
- 包括在1969年至2004年间发表的随机对照试验,重点关注复发性VTE作为结果.
- 数据提取和质量评估由两名审查员独立执行,第三名审查员判断分歧.
主要成果:
- 与短期治疗相比,延长抗凝剂显著降低了复发性静脉动脉突发症的风险 (IRR 0.21).
- 即使在停止长期抗凝药 (IRR 0.69) 后,在预防复发性VTE方面也观察到减少但仍然显著的益处.
- 长期和短期抗凝剂组之间,重大出血事件的风险是可比的.
结论:
- 长时间的抗凝剂在治疗期间提供了保护,防止在治疗期间出现复发性VTE.
- 在延长抗凝治疗停止后,观察到对复发性VTE的残留保护作用.
- 这些发现支持使用扩展抗凝剂来管理VTE,平衡疗效和安全.
相关概念视频
Anticoagulant Drugs: Low-Molecular-Weight Heparins
2.6K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
2.6K
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
2.7K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.7K
Venous Thrombosis I: Introduction
822
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...
822
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
469
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...
469
Venous Thrombosis III: Interprofessional Care
482
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...
482
Venous Thrombosis IV: Nursing Management
415
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,...
415


