Bergmann J-F, Kher A
Clinique Therapeutique, Hôpital Lariboisière, University Paris VII, Paris, France.
Int J Clin Pract. 2005 May;59(5):555-61. doi: 10.1111/j.1368-5031.2005.00529.x.
The risk of venous thromboembolism (VTE) in medical patients is generally underestimated. However, recent studies including two large double-blind placebo-controlled trials, the Prospective Evaluation of Dalteparin Efficacy for Prevention of VTE in Immobilised Patients trial (PREVENT) and prophylaxis in MEDical patients with ENOXaparin, study show that low-molecular-weight heparins (LMWHs) provide effective thromboprophylaxis for medical patients at risk from VTE without increasing the risk of bleeding. In PREVENT the significant 45%, reduction in VTE among patients receiving dalteparin 5000 IU once daily for 14 days was attributed entirely to a reduction in clinically relevant VTE. The recently published guidelines for the prevention and treatment of VTE, issued by the American College of Chest Physicians, recommend prophylaxis with LMWHs (or low-dose unfractionated heparin) in acutely ill medical patients with risk factors for VTE (grade 1A). Current evidence should encourage the more widespread adoption of thromboprophylaxis in at-risk medical patients, and thus reduce the number of preventable deaths and complications due to VTE.
内科患者发生静脉血栓栓塞症（VTE）的风险通常被低估。然而，近期的研究，包括两项大型双盲安慰剂对照试验，即“达肝素预防固定患者VTE疗效的前瞻性评估”（PREVENT）试验以及“依诺肝素用于内科患者预防”研究，表明低分子量肝素（LMWHs）可为有VTE风险的内科患者提供有效的血栓预防，且不会增加出血风险。在PREVENT试验中，接受达肝素5000 IU每日一次共14天治疗的患者中，VTE显著降低45%，这完全归因于临床相关VTE的减少。美国胸科医师学会最近发布的VTE预防和治疗指南建议，对于有VTE风险因素的急性内科患者，采用LMWHs（或小剂量普通肝素）进行预防（1A级）。目前的证据应促使在有风险的内科患者中更广泛地采用血栓预防措施，从而减少因VTE导致的可预防死亡和并发症数量。
