深静脉血栓和肺栓塞
Marcello Di Nisio1, Nick van Es2, Harry R Büller2
1Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University, Chieti, Italy; Department of Vascular Medicine, Academic Medical Centre, Amsterdam, Netherlands.
Lancet (London, England)
|July 5, 2016
概括
诊断静脉血栓塞栓症 (VTE) 需要临床规则和D-二分体测试. 直接口服抗凝剂是首选的治疗方法,在高风险患者中考虑延长治疗.
科学领域:
- 医学
- 心脏病学
- 血液学
背景情况:
- 静脉血栓塞栓症 (VTE),包括深静脉血栓和肺栓塞,是一个重大的全球健康挑战.
- 目前对疑似VTE的诊断策略涉及阶段性方法,结合临床决策规则和D-二次测试.
研究的目的:
- 概述静脉血栓栓塞的诊断和管理指南.
- 强调直接口服抗凝剂作为第一线治疗的作用,并讨论治疗持续时间.
主要方法:
- 顺序应用临床决策规则和D-二次测试以排除VTE.
- 疑似深静脉血栓的超声波和疑似肺栓塞的CT扫描.
- 直接口服抗凝剂与维生素K对抗剂的治疗疗效和安全性比较.
主要成果:
- 患有静脉动脉突发症的可能性较低且D二次体正常的患者可以安全地避免成像和抗凝治疗.
- 与维生素K对抗剂相比,直接口服的抗凝剂显示出较低的出血风险和更好的可用性.
- 血栓溶解仅适用于血液动力不稳定的肺栓塞病例.
结论:
- 诊断途径有效地识别出可以放弃进一步调查和治疗的患者.
- 直接的口服抗凝剂是首选的静脉血栓炎的初始治疗方法.
- 建议使用至少3个月的抗凝药,并根据个人对复发和出血风险的评估考虑延长治疗.
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