Baron RM, Goldhaber SZ
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Thromb Thrombolysis. 1997;4(3/4):365-374. doi: 10.1023/a:1008849416842.
Conventional management of acute deep venous thrombosis (DVT) consists of initiating continuous infusion intravenous unfractionated heparin (UFH) for 5 days in the hospital as well as warfarin. Low-molecular-weight heparins (LMWHs) appear to confer similar protection against recurrent DVT compared with UFH but exhibit prolonged bioavailability, increased ease of dosing, and fewer side effects. The advent of LMWH has resulted in increased numbers of patients undergoing initial management of acute DVT with only several days of hospitalization. While 3-month follow-up studies with LMWH demonstrate similar efficacy and safety to UFH, longer term experience with these new agents is necessary to determine their optimal use and safety. We suggest a system for triage in the initial management of DVT patients for: (1) complete outpatient management with LMWH, or (2) short-term hospitalization for initiation of LMWH, or (3) 5-day hospitalization for treatment with UFH. A review of DVT management with LMWH and algorithms for each of these pathways are provided.
急性深静脉血栓形成（DVT）的传统治疗方法包括在医院连续静脉输注普通肝素（UFH）5天以及使用华法林。与UFH相比，低分子量肝素（LMWH）似乎对复发性DVT具有相似的保护作用，但具有更长的生物利用度、更易于给药且副作用更少。LMWH的出现导致仅住院几天就接受急性DVT初始治疗的患者数量增加。虽然LMWH的3个月随访研究表明其疗效和安全性与UFH相似，但需要更长时间使用这些新药的经验来确定其最佳用途和安全性。我们建议在DVT患者的初始治疗中采用一种分诊系统：（1）使用LMWH进行完全门诊治疗，或（2）短期住院以开始使用LMWH，或（3）住院5天接受UFH治疗。本文提供了对LMWH治疗DVT的综述以及这些治疗途径中每种途径的算法。
