中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (12): 1014-1016.

• 专题笔谈 • 上一篇    下一篇

急性静脉血栓栓塞症抗凝治疗的合理应用

李晓曦   

  1. 中山大学附属第一医院血管甲状腺乳腺外科,广东广州510080
  • 出版日期:2010-12-01 发布日期:2010-11-25

  • Online:2010-12-01 Published:2010-11-25

摘要:

治疗急性静脉血栓栓塞症时最紧迫的目标是预防肺栓塞、降低死亡率,其次是局限血栓范围、减轻症状、预防复发性静脉血栓事件和下肢深静脉血栓形成后综合征。应该即刻开始用肝素或低分子肝素抗凝治疗,同时使用或逐渐过渡到口服维生素K拮抗剂维持抗凝治疗。抗凝治疗可以有效地预防静脉血栓复发,但存在出血的风险,因而应根据静脉血栓复发和出血的风险,进行抗凝治疗时限的临床抉择。例如无诱因的急性静脉血栓栓塞症病人的静脉血栓复发风险较高。对于继发于一过性危险因素的静脉血栓栓塞症、出血风险较高的病例选择短期抗凝治疗;对无诱因的静脉血栓复发病例或有确认长期存在危险因素的静脉血栓栓塞症,如癌症、抗凝血酶缺乏等,选择长期的抗凝治疗。

关键词: 静脉血栓栓塞症, 抗凝

Abstract:

Anticoagulation treatment for acute venous thromboembolism        LI Xiao-xi. Department of Surgery, the First  Affiliated  Hospital, Sun Yat-sen University, Guangzhou 510080, China
Abstract    The immediate goal of treatment for acute venous thromboembolism (VTE) is to prevent pulmonary embolism (PE), reduce morbidity and to limit the size of the clot, relief symptom and prevention of deep vein thrombosis (DVT) recurrence, chronic venous insufficiency and postphlebitic syndrome. Anticoagulation for DVT and PE consists of parenteral administration of heparin or low-molecular-weight heparin overlapped and followed by oral vitamin K antagonists. This treatment is highly efficacious in preventing recurrent VTE events but not devoid of bleeding risk. The clinical decision for duration of anticoagulation therapy in an individual patient depends upon the estimated risks of VTE recurrence and treatment-induced bleeding. The risk of VTE recurrence is higher in idiopathic events.  Therapeutic recommendations may be with shorter duration in case of transient risk factor, or increased bleeding risk, and longer duration in case of a recurrent unprovoked event, especially if permanent risk factors are present.

Key words: venous thromboembolism, anticoagulation