Nutescu Edith A
University of Illinois at Chicago, Department of Pharmacy Practice, Chicago, IL 60612, USA.
Am J Health Syst Pharm. 2007 Jun 1;64(11 Suppl 7):S5-13. doi: 10.2146/ajhp070108.
The long-term complications of deep vein thrombosis (DVT), assessment of risk for venous thromboembolism (VTE) in medical and surgical patients, recommendations in evidence-based guidelines for VTE prophylaxis in surgical and medical patients and the treatment of VTE, and a new alternative for VTE prophylaxis and treatment are discussed.
Pulmonary embolism (PE) is an acute complication of DVT, and recurrent DVT, post-thrombotic syndrome, and death are long-term complications of DVT. The need to assess VTE risk and provide VTE prophylaxis are well recognized in surgical patients. However, VTE prophylaxis is underutilized in medical patients despite the fact that DVT is common and guidelines for prophylaxis are available, partly because the condition often is asymptomatic in these patients. The risk for VTE increases as the number of risk factors increases, so the aggressiveness of VTE prophylaxis in medical and surgical patients increases as the risk of VTE increases. The most recent American College of Chest Physicians (ACCP) guidelines recommend low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) for VTE prophylaxis in acutely ill medical patients. The treatment of VTE recommended by ACCP involves short-term LMWH or unfractionated heparin therapy plus long-term oral warfarin therapy. The pentasaccharide, factor Xa inhibitor, fondaparinux is a new alternative for VTE prophylaxis and treatment. Reducing LMWH doses for patients with severe renal impairment may offer a safety advantage. Fixed doses of LMWH are customarily used for VTE prophylaxis regardless of body weight or body mass index, but weight-based dosing with larger doses for obese patients may be more effective than fixed doses.
Efforts to assess VTE risk and apply evidence-based guidelines for VTE prophylaxis and treatment in medical patients as well as surgical patients can improve patient care and outcomes. Findings from recent clinical research provide clinicians with clarification about the optimal prophylactic and treatment strategies, and future guidelines will reflect these findings.
探讨深静脉血栓形成（DVT）的长期并发症、内科及外科患者静脉血栓栓塞症（VTE）风险评估、基于循证指南对内科及外科患者VTE预防和治疗的建议以及VTE预防和治疗的一种新选择。
肺栓塞（PE）是DVT的急性并发症，复发性DVT、血栓形成后综合征及死亡是DVT的长期并发症。外科患者中评估VTE风险并提供VTE预防措施的必要性已得到充分认识。然而，尽管DVT在内科患者中很常见且有预防指南，但VTE预防措施在内科患者中未得到充分利用，部分原因是这些患者的病情通常无症状。随着风险因素数量的增加，VTE风险也会增加，因此内科及外科患者中VTE预防措施的积极程度会随着VTE风险的增加而提高。美国胸科医师学会（ACCP）最新指南推荐对急性病内科患者采用低剂量普通肝素或低分子肝素（LMWH）进行VTE预防。ACCP推荐的VTE治疗包括短期LMWH或普通肝素治疗加长期口服华法林治疗。戊糖、Xa因子抑制剂磺达肝癸钠是VTE预防和治疗的一种新选择。对于严重肾功能不全患者减少LMWH剂量可能具有安全优势。VTE预防通常使用固定剂量的LMWH，而不考虑体重或体重指数，但对肥胖患者采用基于体重的较大剂量给药可能比固定剂量更有效。
在内科及外科患者中评估VTE风险并应用基于循证指南的VTE预防和治疗措施的努力可改善患者护理及预后。近期临床研究结果为临床医生提供了关于最佳预防和治疗策略的明确信息，未来指南将反映这些研究结果。
