根据德国基于共识 (S2k) 的指导方针,关于脑静脉和持续性鼻血栓的新建议
C Weimar1, J Beyer-Westendorf2, F O Bohmann3
1BDH Klinik Elzach und Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany. christian.weimar@bdh-klinik-elzach.de.
Neurological research and practice
|April 18, 2024
概括
关于脑静脉血栓症 (CVT) 管理的新指导方针强调避免D-二聚体测试和常规血栓性查. 他们建议低分子量肝素 (LMWH) 用于急性CVT和直接口服抗凝剂用于长期治疗.
科学领域:
- 神经学 神经学
- 血管医学 血管医学
- 血栓形成研究研究
背景情况:
- 积累的证据需要更新大脑静脉和持续性鼻血栓 (CVT) 诊断和管理的指南.
- 近年来,在识别风险因素,干预治疗和使用CVT的直接口服抗凝剂方面取得了进展.
研究的目的:
- 根据欧洲中风组织的指导方针,提出CVT诊断和管理的新建议.
- 为奥地利,德国和瑞士的临床医生提供共识驱动的更新.
主要方法:
- 根据GRADE标准和专家共识制定建议.
- 审查关于CVT风险因素,诊断工具和治疗干预措施的新证据.
主要成果:
- 接种SARS-CoV-2疫苗后的CVT可能表明疫苗诱导的免疫血栓性血栓性缺血症 (VITT).
- 对于CVT诊断或管理,不建议进行D-二聚体检测和例行血栓友病查.
- 低分子量肝素 (LMWH) 首选用于急性CVT,在特定情况下考虑内血管再通道.
- 对于即将入狱的情况,可能需要进行手术减压.
- 建议在急性期后的3-12个月内使用直接口服抗凝剂.
- 对于有史以来CVT的女性,关于荷尔蒙避孕药和怀孕的具体建议.
结论:
- 更新的指导方针包含了关于CVT的新证据,包括VITT和抗凝剂的作用.
- 建议旨在优化CVT患者的护理,平衡诊断和治疗策略的风险和益处.
- 虽然证据水平通常很低,但建议得到现有数据和临床经验的支持.
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