Wolozinsky Mia, Yavin Yshai Y, Cohen Alexander T
Academic Department of Surgery, King's College Hospital, London, UK.
Am J Cardiovasc Drugs. 2005;5(6):409-15. doi: 10.2165/00129784-200505060-00008.
Acutely ill general medical patients are at moderate-to-high risk of venous thromboembolism (VTE); approximately 10-30% may develop deep vein thrombosis or pulmonary embolism, the latter being a leading contributor to deaths in hospital. Medical conditions associated with a high risk of VTE include cardiac disease, cancer, respiratory disease, inflammatory bowel disease, and infectious disease. Predisposing risk factors for VTE in medical patients include history of VTE, history of malignancy, complicating infections, increasing age, thrombophilia, prolonged immobility, and obesity. Unfractionated heparin (UFH), low-molecular weight heparin (LMWH), and fondaparinux sodium have been shown to be effective agents in the prevention of VTE in medical patients. In this setting, UFH has a higher rate of bleeding complications than LMWH. There is no evidence supporting the use of aspirin, warfarin, or mechanical methods to prevent VTE in medical patients. We recommend either LMWH or fondaparinux sodium as well tolerated and effective thromboprophylactic agents in medical patients.
急重症普通内科患者发生静脉血栓栓塞症（VTE）的风险为中到高度；约10%-30%的患者可能会发生深静脉血栓形成或肺栓塞，后者是导致住院患者死亡的主要原因之一。与VTE高风险相关的内科疾病包括心脏病、癌症、呼吸系统疾病、炎症性肠病和传染病。内科患者发生VTE的易感风险因素包括VTE病史、恶性肿瘤病史、并发感染、年龄增长、血栓形成倾向、长期制动和肥胖。普通肝素（UFH）、低分子肝素（LMWH）和磺达肝癸钠已被证明是预防内科患者VTE的有效药物。在此情况下，UFH的出血并发症发生率高于LMWH。没有证据支持在内科患者中使用阿司匹林、华法林或机械方法预防VTE。我们推荐LMWH或磺达肝癸钠作为内科患者耐受性良好且有效的血栓预防药物。
