Goldhaber Samuel Z
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Semin Thromb Hemost. 2003 Dec;29 Suppl 1:23-31. doi: 10.1055/s-2003-45414.
Pulmonary embolism (PE) and deep venous thrombosis (DVT) remain major problems in medicine that receive less attention from healthcare professionals and the public than either coronary artery disease or acute myocardial infarction. Furthermore, strategies proven to minimize the frequency of PE and DVT are not widely employed on a consistent and effective basis. The problem is widespread and affects patients in acute care hospitals, rehabilitation hospitals, and skilled nursing facilities, as well as high-risk individuals at home. Internists, general practitioners, and family doctors confront the greatest challenges in implementing appropriate prophylaxis. Models for effective change exist in cardiovascular and surgical practices where the imperative for prevention of further disease is insisted upon and ingrained in the culture of clinicians. We will review the epidemiology of venous thromboembolism, strategies for the primary and secondary prevention of PE and DVT, "real world" use of prophylaxis, barriers to change that exist in the "real world," and initiatives to improve day-to-day practice. We will conclude by posing 10 questions for future research on this topic.
肺栓塞（PE）和深静脉血栓形成（DVT）仍然是医学领域的重大问题，与冠状动脉疾病或急性心肌梗死相比，医疗保健专业人员和公众对它们的关注较少。此外，已被证明可将PE和DVT发生频率降至最低的策略并未在一致且有效的基础上得到广泛应用。这个问题很普遍，影响着急症医院、康复医院和专业护理机构的患者，以及在家中的高危个体。内科医生、全科医生和家庭医生在实施适当的预防措施方面面临着最大的挑战。在心血管和外科实践中存在有效的变革模式，在这些领域，预防进一步疾病的必要性得到坚持，并深深融入临床医生的文化中。我们将回顾静脉血栓栓塞症的流行病学、PE和DVT的一级和二级预防策略、预防措施在“现实世界”中的应用、“现实世界”中存在的变革障碍，以及改善日常实践的举措。我们将通过提出10个关于该主题未来研究的问题来结束本文。
