Gumulec J, Penka M, Bezdĕk R, Wróbel M, Kessler P, Brejcha M, Klodová D, Sumná E, Králová S
Centrum pro trombózu a bemostázu pri Onkologickém centru J. G. Mendla, Nový Jicín.
Vnitr Lek. 2006 Mar;52 Suppl 1:6-16.
This article summarizes the published data on the prevention of venous thromboembolism. Routine thromboprophylaxis is the best way to lower the risk. It is recommended to sort patients according the thrombosis risk and to make use of the standard prophylactic modes. In low risk patients, no specific thromboprophylaxis is needed. Patients with moderate risk levels are candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression. At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people after major orthopaedic surgeries and with a history of heparin induced thrombocytopenia over the past three months. An alternative to the administration of LMWH even after the end of the hospitalization can be warfarin in certain situations. The sole use of acetylsalicylic acid or Rheodextran is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis.
本文总结了已发表的关于预防静脉血栓栓塞的数据。常规血栓预防是降低风险的最佳方法。建议根据血栓形成风险对患者进行分类，并采用标准的预防模式。低风险患者无需特殊的血栓预防措施。中度风险水平的患者可在高风险期每天皮下注射剂量低于3400抗Xa单位的低分子量肝素（LMWH），而风险增加的患者则每天注射高于3400抗Xa单位的剂量。为降低出血风险，可在手术前2小时或手术后4 - 6小时给予半剂量。在最高风险情况下，建议将超过3400抗Xa单位的LMWH与弹性连裤袜联合使用，或者与间歇性气动压迫联合使用。在中度风险水平时，也可每天两次皮下注射5000单位的普通肝素，在风险增加时，在风险增加期每天三次给药。对于有显著出血风险的患者，可采用物理血栓预防方法，在出血风险过去后开始药物预防。磺达肝癸钠是大型骨科手术后患者以及过去三个月有肝素诱导的血小板减少病史患者的LMWH替代药物。在某些情况下，即使在住院结束后，华法林也可替代LMWH给药。不建议单独使用乙酰水杨酸或右旋糖酐。在进行硬膜外麻醉或镇痛时，必须严格遵循药物血栓预防的使用指南。
