Aronow Wilbert S
Division of Cardiology, Department of Medicine, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595, USA.
J Gerontol A Biol Sci Med Sci. 2004 Jan;59(1):42-7. doi: 10.1093/gerona/59.1.m42.
The rationale for thromboprophylaxis is based on the high prevalence of venous thromboembolism (VTE), a disorder involving deep vein thrombosis (DVT) and pulmonary embolism (PE), among hospitalized patients, the clinically silent nature of VTE in most patients, and the morbidity, cost, and potential mortality associated with unprevented thromboembolism. Both DVT and PE cause few specific symptoms, and the clinical diagnosis is unreliable. Since the first clinical manifestation of VTE may be fatal PE, it is inappropriate to wait for symptoms before treatment. Unrecognized and untreated DVT may also cause the postphlebitic syndrome and predispose patients to subsequent episodes of recurrent VTE. Routine screening for VTE has also not been shown to reduce the incidence of symptomatic VTE or fatal PE. Use of effective methods of prophylaxis is more cost effective and is safer than selective, intensive screening for VTE. This article reviews current recommendations for the prevention of VTE as they apply to older adults. The recommendations discussed are based on the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy reported in Chest. 2001;119:132S-175S.
血栓预防的基本原理基于住院患者中静脉血栓栓塞症（VTE，一种涉及深静脉血栓形成（DVT）和肺栓塞（PE）的疾病）的高发病率、大多数患者VTE的临床隐匿性，以及与未预防的血栓栓塞相关的发病率、成本和潜在死亡率。DVT和PE都很少引起特定症状，临床诊断并不可靠。由于VTE的首个临床表现可能是致命性PE，因此等待症状出现后再治疗是不合适的。未被识别和未治疗的DVT也可能导致血栓形成后综合征，并使患者易患复发性VTE的后续发作。常规筛查VTE也未显示能降低有症状VTE或致命性PE的发生率。使用有效的预防方法比选择性、强化筛查VTE更具成本效益且更安全。本文综述了当前适用于老年人的VTE预防建议。所讨论的建议基于《胸部》杂志报道的第六届美国胸科医师学会抗栓治疗共识会议。《胸部》2001年；119：132S - 175S。
