抗凝血治疗患者的复发性静脉血栓栓塞:根据修订的AWMF S2k指南进行更新
Robert Klamroth1, Hanno Riess2, Jan Beyer-Westendorf3
1Department of Internal Medicine and Vascular Medicine, Vivantes Hospital in Friedrichshain, Berlin, Germany.
Hamostaseologie
|April 30, 2024
概括
复发性静脉血栓栓塞 (VTE) 影响2%的抗凝药患者. 调查癌症或罕见疾病等潜在原因对于正确诊断和管理突破性VTE事件至关重要.
科学领域:
- 医学 医学 医学 医学 医学
- 血液学 血液学 血液学
- 心脏病学 心脏病学
背景情况:
- 抗凝药对静脉血栓塞栓症 (VTE) 非常有效,但大约2%的患者在治疗期间出现了复发性VTE.
- 复发性VTE诊断需要了解主要事件的局部和血栓负担.
- 复发性VTE的潜在原因包括药物不坚持,次治疗药物水平,以及由潜在疾病引起的高血栓发生率.
研究的目的:
- 强调在接受抗凝治疗的患者中诊断复发性VTE的重要性.
- 强调需要调查突破性VTE事件的潜在原因.
- 提供建议,以考虑复发性VTE病例中的特定条件.
主要方法:
- 审查更新的德国S2k关于静脉血栓和肺栓塞的指南.
- 在接受抗凝药治疗的患者中,对复发性静脉瘤的潜在原因的分析.
- 考虑对乙素诱导的II型血小板缺血的诊断方法.
主要成果:
- 癌症是与复发性VTE相关的最常见的潜在疾病.
- 抗脂综合征,阳性夜间血红蛋白尿和贝赫特病在静脉瘤复发时应考虑.
- 在肝素治疗期间,即使血小板数量正常,也必须排除乙型肝素诱导的血小板缺血.
结论:
- 正确诊断复发性VTE是必不可少的,并且取决于对主要事件的了解.
- 建议对恶性瘤或罕见疾病等潜在疾病进行突破性VTE事件的调查.
- 在抗凝血药患者中治疗复发性VTE的临床证据有限,通常依赖于专家意见.
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