静脉血栓塞栓症的治疗方法
Philip S Wells1, Melissa A Forgie2, Marc A Rodger3
1Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada2Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada.
JAMA
|February 20, 2014
概括
静脉血栓栓塞 (VTE) 治疗主要涉及抗凝剂. 新的口服抗凝剂为所有VTE治疗阶段提供了简化,安全和有效的选择,尽管个性化风险评估至关重要.
科学领域:
- 心血管医学 心血管医学
- 血液学 血液学 血液学
- 药理学 药理学是指药理学的学科.
背景情况:
- 静脉血栓塞栓症 (VTE),包括深静脉血栓症 (DVT) 和肺栓塞 (PE),是一种普遍且可能致命的疾病.
- 有效管理VTE需要了解其独特的治疗阶段:急性,长期和扩展.
研究的目的:
- 审查目前对VTE病因学的理解.
- 概述VTE急性,长期和延长阶段的基于证据的治疗策略.
主要方法:
- 综合的文献搜索,包括柯克兰评论,元分析和随机对照试验.
- 咨询美国胸部医生学院的抗血栓治疗指南和专业组织指南.
- 包括成本效益研究和内部文献数据库审查.
主要成果:
- 急性DVT的门诊治疗是可行的低分子量肝素 (LMWH) 或新的口服抗凝剂,可以作为单一治疗.
- 根据严重程度和预后,急性PE也可以作为门诊治疗;血栓溶解和IVC过器只适用于特定的严重病例.
- 标准治疗持续时间为3个月,延长治疗的决定基于复发风险和出血风险;新的口服抗凝剂在所有治疗阶段都显示出有前途.
结论:
- 抗凝药仍然是VTE治疗的基石,干预只适用于特定的适应症.
- 存在各种治疗选择,需要根据病因,风险,益处,成本和患者偏好考虑量身定制的策略.
- 需要进一步的研究来完善个人风险预测,以实现最佳的VTE管理.
相关概念视频
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
Pulmonary Embolism III: Nursing Management
756
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...
756
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
749
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
749
Varicose Veins II: Diagnostic Studies and Interprofessional Care
319
Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
319
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


