Schulman Sam
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Ann Med. 2008;40(5):352-9. doi: 10.1080/07853890802010717.
During the past two decades well designed randomized controlled trials have addressed every important aspect of prophylaxis against venous thromboembolism (VTE) and treatment of established VTE. In addition, systematic reviews and meta-analyses have been performed in most of these areas. The most important advances are the widely accepted and effective VTE prophylaxis in major orthopedic surgery and the shift from in-hospital to outpatient treatment of a majority of patients with established VTE. The major hurdles at this point are efficient selection of the appropriate medically ill patients for prophylaxis and the inconvenience of long-term secondary prophylaxis with vitamin K antagonists. Although new, orally available anticoagulants without need for monitoring or dose adjustments have been in clinical trials for a decade, none is approved yet, and will not be discussed in this review.
在过去二十年中，精心设计的随机对照试验已涉及静脉血栓栓塞症（VTE）预防和已确诊VTE治疗的各个重要方面。此外，在这些领域中的大多数都进行了系统评价和荟萃分析。最重要的进展是在大型骨科手术中广泛接受且有效的VTE预防，以及大多数已确诊VTE患者从住院治疗向门诊治疗的转变。目前的主要障碍是有效筛选适合预防的内科疾病患者，以及使用维生素K拮抗剂进行长期二级预防带来的不便。尽管无需监测或调整剂量的新型口服抗凝剂已进入临床试验十年，但尚无一种获得批准，本综述也不会对此进行讨论。
