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静脉血栓栓塞:诊断和治疗方面的进展
Tobias Tritschler1, Noémie Kraaijpoel2, Grégoire Le Gal3,4
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
JAMA
|October 17, 2018
概括
在静脉血栓栓塞 (VTE) 诊断和治疗方面取得的进展使护理变得更加简单. 新的策略允许对深静脉血栓 (DVT) 和肺栓塞 (PE) 进行个性化治疗,从而提高安全性和结果.
科学领域:
- 心血管医学
- 血液学
- 医疗诊断
背景情况:
- 静脉血栓塞栓症 (VTE),包括深静脉血栓症 (DVT) 和肺栓塞症 (PE),是全球严重的健康负担.
- 由于该病的发病率和死亡率很高,因此对静脉瘤的有效治疗至关重要.
研究的目的:
- 提供过去五年内静脉突发症诊断和治疗的最新进展的综合报告.
- 突出临床实践和治疗方法的关键变化.
主要方法:
- 在主要的生物医学数据库 (EMBASE,MEDLINE) 中进行了系统的文献搜索,搜索了2013年1月至2018年7月期间发表的研究.
- 包括系统审查,元分析,随机对照试验和前性队列研究,并补充了临床指南的查.
主要成果:
- 根据年龄调整的D-分位数值和肺栓塞排除标准提高了PE的诊断准确性,减少了成像的需要.
- 直接口服抗凝药 (DOAC) 提供简化静脉突发症治疗,降低出血风险,促进延长的二次预防.
- 血栓溶解仅用于严重的PE或危及四肢的DVT;只有在抗凝剂适用时,下腔静脉过器才适用. 不建议使用渐进式压缩治疗DVT,但可能会缓解症状.
结论:
- 在VTE管理方面取得了重大进展,使得量身定制的诊断和治疗策略成为可能.
- 目前的方法允许个性化的患者护理,考虑到个人特征,偏好和价值观.
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