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肺栓塞的预防性抗凝血
Christopher Woo1, Wei Sun1, Paul Thein1
1Department of Medicine, Monash Health, Melbourne, Victoria, Australia.
Internal medicine journal
|July 25, 2023
概括
预防性抗凝血治疗肺栓塞 (PE) 很少使用,无论患者的风险如何. 这表明,对出血风险的担忧可能会在疑似PE病例中超过未经证实的益处.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
背景情况:
- 肺栓塞 (PE) 是一种严重的疾病,需要高风险患者立即服用抗凝剂.
- 目前的指导方针建议基于PE的预测概率进行预防性抗凝治疗.
研究的目的:
- 评估在疑似PE病例中使用预防性抗凝剂的使用情况.
- 将急诊室 (ED) 的抗凝剂使用与住院病房和风险评估得分分层分.
主要方法:
- 对392名接受CT肺血管造影 (CTPA) 的患者进行了回顾性观察队列研究.
- 根据使用修订日内瓦评分 (RGS) 的风险分类的患者分为低 (0-3) 和中高 (>3) 风险组.
- 基于CTPA请求的位置 (ED与病房) 的抗凝剂使用分析.
主要成果:
- 只有7.4%的患者接受了预防性抗凝药.
- 抗凝药的使用与PE风险分层 (RGS) 不相关.
- 在ED (2.8%) 中,CTPA诊断收益率较低,但在病房 (25.4%) 中较高.
结论:
- 对疑似PE的预防性抗凝药很少使用,并且不依据验证的风险评分.
- 低利用率可能源于对出血并发症的担忧,而没有被证明的有效性.
- 在疑似PE的ED中,CTPA的诊断收益率很低.
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