Haas Sylvia, Spyropoulos Alex C
Institut für Experimentelle Onkologie und Therapieforschung, Universität Munchen, Ismaninger Strasse 22, Munich, Germany.
Clin Appl Thromb Hemost. 2008 Apr;14(2):149-58. doi: 10.1177/1076029607311779.
Venous thromboembolism (VTE) is a significant, but underestimated, cause of morbidity and mortality in long-term care settings. VTE risk increases significantly with age and is further increased by comorbidities common to this group; however, advancing age and limited mobility alone are insufficient to warrant pharmacological prophylaxis. Recognizing those at increased VTE risk during an acute illness is crucial for appropriate and timely prophylaxis. Warfarin is used for the long-term secondary prevention of VTE, whereas unfractionated and low-molecular-weight heparins are used for primary prophylaxis. The elderly are at increased risk for bleeding complications, because of the high frequency of comorbidities and comedications. Attention to dosing is recommended for those with severely impaired renal function, low body weight, or perceived to be at high bleeding risk. This review addresses the role of risk assessment in the decision of when to provide prophylaxis to an individual in long-term care and highlights key management issues for those prescribed prophylaxis.
静脉血栓栓塞症（VTE）是长期护理机构中发病和死亡的一个重要但被低估的原因。VTE风险随年龄显著增加，且因该群体常见的合并症而进一步升高；然而，仅年龄增长和活动受限不足以成为药物预防的依据。在急性疾病期间识别VTE风险增加的患者对于适当和及时的预防至关重要。华法林用于VTE的长期二级预防，而普通肝素和低分子肝素用于一级预防。由于合并症和合并用药的频率较高，老年人发生出血并发症的风险增加。对于肾功能严重受损、体重低或被认为出血风险高的患者，建议注意给药剂量。本综述探讨了风险评估在决定何时为长期护理中的个体提供预防措施方面的作用，并强调了接受预防治疗患者的关键管理问题。
