下肢静脉血栓栓塞的诊断和治疗:一个审查
Romain Chopard1,2, Ida Ehlers Albertsen3,4, Gregory Piazza5
1Department of Cardiology, University Hospital Jean Minjoz, Besançon, France.
JAMA
|November 3, 2020
概括
深静脉血栓形成的风险随着年龄的增长而增加,新的抗凝药物是有效的. 直接的口服抗凝药与华法林一样有效,但其出血风险较小,尽管成本可能是一个障碍.
科学领域:
- 血管医学
- 血液学
- 临床血栓研究
背景情况:
- 深静脉血栓 (DVT) 在每10万人/年中发生88-112例,随着年龄的增长而增加.
- 在事件发生后的10年内,复发性静脉血栓栓塞 (VTE) 发生率在20-36%之间.
- 危险因素包括年龄,恶性瘤,炎症和遗传性血栓性疾病.
研究的目的:
- 审查目前对DVT危险因素的理解.
- 评估下肢DVT的诊断策略.
- 评估现代抗凝血疗法的有效性和安全性.
主要方法:
- 在PubMed和Cochrane数据库进行系统的文献搜索 (2015-2020年).
- 包括随机临床试验,元分析,系统审查和观察性研究.
- 专注于危险因素,诊断方法 (D-二次数,威尔斯分数,超声波) 和治疗结果.
主要成果:
- 与预试验概率评估工具相结合的D-二聚体测试有助于排除急性静脉瘤.
- 在DVT诊断后3-6个月内,25- 50%的患者出现血栓后综合征.
- 直接口服抗凝剂 (DOAC) 的疗效与华法林无差,出血率较低 (1. 1% 与 1. 8% 相比).
结论:
- 在识别静脉瘤风险因素和抗凝药方面取得的进步改善了深血管瘤的治疗.
- 与华法林相比,DOACs具有较好的疗效和安全性.
- 对于广泛采用DOAC,成本仍然是一个考虑因素.
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